I would appreciate your comments re an end of life issue. My 90 year old mother is in a nursing home and suffers from very severe dementia. She does not know who I am nor does she recognize my brothers or my wife or her great grandchildren. My brother who lives fairly close to the nursing home has power of attorney, etc. I live a distance away in another state. I was just informed today that my my mother was put under a Do Not Medicate order by her doctor with the consent of my brother, a thoughtful Catholic. I note that my mother spits out her medication and fights with anyone who attempts to medicate her. I know that refusing food and hydration is contrary to Church teaching as is euthanasia but I also know that the Church does not require “heroic measures.”. My question for my fellow CAFers: is a Do Not Medicate Order a morally acceptable response to someone in my mother’s condition? I would appreciate your thoughts (and prayers for all concerned) on this matter.
I sympathize and will pray for your mother and family. My mother is in a similar situation after suffering a massive stroke and I can only let you know what we agreed to. We said "under no circumstances was mother to be deprived of food, drink or any medication. If she was in pain, she was to be given pain killers, if she had an infection she was to be given antibiotics etc.
The Nursing Home were content and when mother spits out medication, they apply it in a patch (it looks like a tiny plaster and the medicine is absorbed through the skin). I do not know what medication you are referring to, but there is no excuse for a doctor or caregiver not to give pain relief.
With regard to resuscitation we said that due to her brittle bones, it would be distressing, frightening and unlikely to achieve any benefit for her, therefore, when her heart stops, it is her time.
That is our situation, however, I as I do not know the medication your mother receives, if your brother was pressured by anyone or what advice your brother may have received from his Priest, it is difficult to offer any advice other than to pray and for you to consult with your (or even your brother’s) Priest. If you disagree with your brother’s decision, please tread lightly and try to be gentle. You have every right to kindly ask why he did not consult with you (maybe he could have called) but bear in mind he might not have been thinking clearly at the time.
You don’t mention anything about discussions around giving the medication covertly.
Something like 80% of elderly patients with advanced dementia receive their medication this way.
Has this been discussed and ruled out?
If not, it might be worth pursuing with the care home authorities?
As a retired Nurse, I can tell you that some States forbid (legally) “hiding” meds in foods other than crushed in applesauce, which doesn’t hide the taste!. I also had a number of patients who would spit out meds and fight. When the State Inspectors were not around, OR with a specific M.D. order, we would give essential meds such as cardiac meds, or meds for diabetes, crushed and put in a tasty pudding, just to maintain our lovely patients. The facility would not purchase the puddings, so most of the nurses purchased 6 - packs of nice puddings, such as tapioca (which is really easy to hide crushed meds in), but the most popular pudding for our patients was chocolate, and it hides the taste of meds beautifully! However, we did have M.D.'s, who with family agreement (whoever had the Power of Attorney), to cease all meds. This is not the same as withholding essential fluids and foods. It depends a lot on the meds. The one thing we could NOT cease was Insulin injections, which was often a battle, and in fact, I was permanently disabled by a patient who was a “brittle diabetic” in Hospice/Terminal Care who also had dementia. I was thrown into a door frame and had my tibia crushed for 2 inches, which resulted in difficulty walking & ended my outside work as a Nurse. I would do it again, just to keep my patient from dying of the diabetes when I could prevent that. Speak to your brother (and perhaps the Director of Nursing at the facility) about what type of meds she is on. And, have them explain what the meds are for! If none of them are required to maintain life (as insulin is), then this is NOT a life-threatening order from the Doctor. What they are basically doing is letting her go on naturally to her eventual end, and avoiding injury to her or to her Nurses.
However, they should do all they can to continue hydration (I even bought milk shakes (out of my own pocket) for those who would not take water, juice or other liquids) just to make sure they were hydrated, and which also provided some calories. If she is eating or accepting at least some foods and fluids, and the meds are not essential to maintain life (few meds will cause death if ceased when a patient is suffering from end stage dementia) then the order is basically legal, and will probably not cause any immediate harm due to lack of the medications. You should speak to your brother about her medications and find out how essential they might be to life. If it is a case of the facility not wanting to put out extra effort to get meds into her, they are not doing their jobs! And, they may have pressured your brother and the M.D. to cease them, rather than trying to work around the problem another way.
I had only a couple of “no medication” orders in the 18 years I worked as a Hospice/Terminal Care Nurse, and NONE of them cancelled any pain meds. There are meds which can taste good, or which can be concealed to give in liquid or food for pain. (Such as Roxanol, which is used for cancer patients in place of regular Morphine, and which is a small amount of liquid absorbed directly through the cheeks and gums.). I hope you find the answers and peace you need. There is nothing worse than arguing with family AFTER the death of a parent because some think the one who had the Medical authority actually “killed” the parent. This is seldom true!! Will say a prayer for your peace and that you achieve understanding with your brother and your Mother’s caregivers!
By the way, if they are having trouble getting foods and liquids into her, the FAMILY can provide such things as cans of “Boost” in her favorite flavors, puddings, milk shakes, etc… That will at least get her to take some calories and fluids. If one or two meds are absolutely essential, they can be placed in the puddings WITH a M.D. order. Watch out – as I said at the beginning, some States forbid hiding meds in food without an specific MD order, and there must be justification for it documented! God help you and grant you peace. Remember, your brother is living much closer to this and is watching what is happening on a daily or weekly basis, which must be very hard on him too!