Easeful death

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#1 May 12th, 2018, 13:36
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I have often been attracted by these lines of Keats "For many a time I have been half in love with easeful Death..............Now more than ever seems it rich to die, To cease upon the midnight with no pain, While thou art pouring forth thy soul abroad , In such an ecstasy!" I think at some stage many of us may think and perhaps desire an easeful death as we see many suffering at the end waiting for the doors of death to open.

I am now disturbed by the thought of easeful death as my 95 years old mother who had been bedridden for the last several years, is now refusing to have any food or even drink. She had been living without any serious problems, being looked after by a committed and sincere maid for the last few years and before that my sister in law and brother looked after her.

I am in a dilemma, as some of my close friends including a very good doctor tell me that it will be torturing her if we take her to a hospital and resort to nasal feeding through a ryles tube. But one of my doctor friends tells me that we have to resort to nasal feeding to keep her alive. Naturally I am a little confused.
#2 May 12th, 2018, 13:57
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Are looking for a moral path or an ethical roadmap ? You are aware of David Goodall, an australian ecologist, last week went to switzerland to end his life !
#3 May 12th, 2018, 14:02
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I think you may want to note whether she knows what she is doing and what it would mean. If she is not in distress and says that I have seen a lot and have spent my time fruitfully here, I would like to move on - I think you could accept it. But if she is having these feelings because of pain and distress due to her present condition, you could try further to alleviate her discomfort and see if she is willing to stay with you further.
Just a view point, which would differ according to conditions..
I had my grandmother in law - who was bed ridden. She had asked to not give her any more medicines. Food and water was fine.
Guess this differs a lot because of the last two being refused as well.
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#4 May 12th, 2018, 17:08
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Originally Posted by narayanvee View Post
I am in a dilemma, as some of my close friends including a very good doctor tell me that it will be torturing her if we take her to a hospital and resort to nasal feeding through a ryles tube. But one of my doctor friends tells me that we have to resort to nasal feeding to keep her alive. Naturally I am a little confused.
Sorry to hear of your dilemma Narayan Bhai. It's difficult to accept parting with a loved one. But from my own experience of seeing old people pass, it seems like they know when it is time or they are ready to go. Why does your doctor friend think it's necessary to keep her alive? (I suppose because that's his job) If you feel your mother is ready to go then let her go, i'm sure at her age most of us would prefer to go in our own way, rather than stay & go through much suffering.

“Life is not the opposite of death. The opposite of death is birth. Life is eternal”
Eckhart Tolle

B.Gita Ch2

11. Thou grieveth for those, who need not be grieved for, yet speaketh words of wisdom. The wise grieve neither for the living nor the dead.

12. It is not that I never existed, nor you, nor these rulers of men. It is not that we shall cease to be hereafter.

13. Just as in this body the embodied soul passes through childhood, youth, and old age, so also it passes into another body. In this matter the wise do not grieve.
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#5 May 12th, 2018, 17:22
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#5
I don't know what to say except sorry.

I know what my mother would have wanted, but, of course that was not possible. And, along with not being able to eat any longer, she was dying of various stuff, and did not last long at that final decline. I don't know, and can't even suggest, for anybody else.
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#6 May 12th, 2018, 18:03
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Originally Posted by nycank View Post Are looking for a moral path or an ethical roadmap ? .......
Neither, I have to say. I would like to hear from people who had similar experience and decide. I am more interested on the medical side.

Quote:
Originally Posted by snotty View Post I think you may want to note whether she knows what she is doing and what it would mean. If she is not in distress and says that I have seen a lot and have spent my time fruitfully here, I would like to move on -----------
Thanks snotty;She is not in pain or distress. She just says that she doesn't want anything and occasionally takes one or two sips of tender coconut water or mild tea with milk.She smiles at persons who come to see her. But most of the time she is half asleep. I don't think her refusal is out of a thought out decision; but more of a physical reaction. I cannot understand.

Quote:
Originally Posted by kullukid View Post Sorry to hear of your dilemma Narayan Bhai. It's difficult to accept parting with a loved one. But from my own experience of seeing old people pass, it seems like they know when it is time or they are ready to go. Why does your doctor friend think it's necessary to keep her alive? (I suppose because that's his job) ...........
“Life is not the opposite of death. The opposite of death is birth. Life is eternal”
Eckhart Tolle
B.Gita Ch2
11. Thou grieveth for those, who need not be grieved for, yet speaketh words of wisdom. The wise grieve neither for the living nor the dead.
.
Thanks KKJI. I shall be worried in the least if I am sure that she refuses food being fully aware of what she is doing ; but I cannot understand whether it is just a physical reaction. No way to assess that.
#7 May 12th, 2018, 18:27
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#7
It is rather easy to sit and give suggestions, but very difficult to take the actual decision.

I think there would be two ways to approach this -
1. Medical - No doctor shall let a patient die as far as he can and definitely not till he is sure that he has tried his best to address all the issues that are in play. If the patient is not in a clear consciousness and not able to take decisions that seem rational (based on her past disposition), I believe we need to continue with the medical treatment that is most suitable for her needs. (a patient who is drowsy more often than not may not be able to make the best medical decision)

2. Humanitarian - Apart from the medical illness, is she conscious and oriented or does she just drifts in and out of sleepy state and consciousness. Is she here for herself or are we asking her to stay here for us. The better way would have been to be in her shoes and make a decision based on her approach to things in the past.

I have worked in ICUs in the earlier days and I have seen doctors playing god. The decisions were based on algorithms - is the patient going to have a quality life - yes, continue treatment. If the patient would be on life support or require extensive support for even the most basic activities, we would talk to the relatives and on one or two occasions have taken decisions based on consensus of the treating team when we were not able to make the relative to see reason. (unethical, but may be the need of the hour then).
There are never easy answers to life and death decisions.
#8 May 12th, 2018, 23:59
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Originally Posted by narayanvee View Post ...who had been bedridden for the last several years...She had been living without any serious problems
Being bedridden for several years IS a very serious problem. And not eating is an end-stage symptom.

Have you ever had a feeding tube up your nose? I have. It is sheer torture. Any doctor who suggests nasal feeding under these end-stage circumstances should be stripped of his or her license, have lassi poured on his head, and run out of town sitting backwards on a donkey...(sorry, childhood imagery, don't know the source).

"Thou shalt not kill, but needst not strive
officiously to keep alive"
(even when it profits the doctor or hospital)

People shouldn't be kept alive to satisfy their relatives' emotional needs. When there is no quality of life, they have to be let go. That is what hospice care does in the western world. The goal is to keep them comfortable and alleviate pain to the extent possible, without force-feeding or other police state tactics..

There is no concept of hospice in India, and India's draconian laws about morphine and other opiods are responsible for untold suffering at the end of life, often in the guise of filial love and respect for life.
Last edited by RPG; May 13th, 2018 at 04:36..
#9 May 13th, 2018, 05:39
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#9
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Originally Posted by narayanvee View Post I am now disturbed by the thought of easeful death as my 95 years old mother who had been bedridden for the last several years, is now refusing to have any food or even drink. She had been living without any serious problems, being looked after by a committed and sincere maid for the last few years and before that my sister in law and brother looked after her.

I am in a dilemma, as some of my close friends including a very good doctor tell me that it will be torturing her if we take her to a hospital and resort to nasal feeding through a ryles tube. But one of my doctor friends tells me that we have to resort to nasal feeding to keep her alive. Naturally I am a little confused.

First, sorry for your emotional pain.

Secondly, let her go. If your mother has been refusing food or drink she knows what she wants to do if she is in her "right mind", i.e., does not have dementia or cognitive impairment and is still capable of carrying on a lucid conversation, etc. And "have to resort" is utter bullshit. Against your mother's wishes?! That's unconscionable. It's her body.

This is exactly the situation why in America we have Health Care Powers of Attorney and Do Not Resuscitate Orders because it's up to the person to decide how things will be when it's their time. I had surgery last year that required general anesthesia and a DNR order was the first thing I handed the dr because I know how things can go wrong under anesthesia for whatever reason.

I agree 100% with RPG that "people shouldn't be kept alive to satisfy their relatives' emotional needs. When there is no quality of life, they have to be let go."

As RPG said, that's why there are hospices and palliative care and death/end of life doulas in the West. Anything else is barbaric.

I wish you peace in your decision.
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#10 May 13th, 2018, 07:13
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You are in a tough spot. Because she is your mother you are torn by dilemma.
You do know the answer but you want validation from others, I could be wrong.

You want to gather perspective from doctors you said. They will not decide for you. So what to do then?
Search for ‘how doctors prefer to die’ or something like that and then make a decision.
Last edited by surya2015; May 13th, 2018 at 08:57..
#11 May 13th, 2018, 08:19
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Originally Posted by surya2015 View Post You are in a tough spot. Because she is your mother you are torn with the dilemma.
You do know the answer but you want validation from others, I could be wrong.
...............
The simple answer is that I don't know the answer. What I want is not validation, but sharing of experience of others who had similar experience.
See what RPG said @RPG "Have you ever had a feeding tube up your nose? I have. It is sheer torture" I do not know how irritating nasal feeding is as I did not get any feed back before. Some doctors say that it is nothing but a simple procedure, very common.

By the way my mother's younger sister who is almost in a coma now, and who had not been able to swallow even liquids as the food entered into her larynx causing lung infection had to resort to nasal feeding. She has been bedridden for the last few months. I have seen her trying to pull out the Ryles tube earlier and her right hand was tied.This situation really disturbs me and that is the reason for my doubts.Yet a doctor friend of mine says it is nothing but a simple thing. May be he is speaking about the technical aspect. My mother has no difficulty to swallow, but she just do not like to have any food or drinks as I already said.
#12 May 13th, 2018, 08:40
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Don't go for tube feeding. If Iam 92 thats what I would want for myself -absolutely no tube feeding, no hospitalization, no treatment whatsoever.

Quote:
Originally Posted by narayanvee View Post The simple answer is that I don't know the answer. What I want is not validation, but sharing of experience of others who had similar experience.
See what RPG said @RPG "Have you ever had a feeding tube up your nose? I have. It is sheer torture" I do not know how irritating nasal feeding is as I did not get any feed back before. Some doctors say that it is nothing but a simple procedure, very common.

By the way my mother's younger sister who is almost in a coma now, and who had not been able to swallow even liquids as the food entered into her larynx causing lung infection had to resort to nasal feeding. She has been bedridden for the last few months. I have seen her trying to pull out the Ryles tube earlier and her right hand was tied.This situation really disturbs me and that is the reason for my doubts.Yet a doctor friend of mine says it is nothing but a simple thing. May be he is speaking about the technical aspect. My mother has no difficulty to swallow, but she just do not like to have any food or drinks as I already said.
#13 May 13th, 2018, 09:28
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#13
Why take other people's word for it? ask your doctor friend to insert a tube in your nose, and keep it on for 24 hours.

But let's assume that the tube is painless. What does it achieve? Is she going to get better? I can't judge that from a distance, but you can, and as Surya2015 has perceptively put it, you already know. It is important not to extend suffering unless there is any rational expectation of recovery.

Let me put it this way. For most of a person's life, letting them die is immoral. But there is also a period during which forcing them to live is immoral; but because this state is brief, we get trained to believe that letting someone die is always immoral. That is not true.
#14 May 13th, 2018, 10:16
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#14

Easeful death

THIS IS MY MOTHER AS ON TODAY:Just to see how she is now.

Name:  AMMA 13.5.18.jpg
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#15 May 13th, 2018, 10:36
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This is not a journey in which others can really help. We all can give our current views "at the moment". With or without guidance, our ethical roadmap keeps dodging potholes and rabbit holes.

I do not want to distract or take a ramp off, from your dilemma. But, having said that; Our brain, holds perfectly valid but conflicting and diametrically opposite values, and views at the same time. Sometimes those neural circuits cause one to be in a bind, which is fine.

There is a raging national debate going on in a very devoutly catholic country going one right now ! Ireland, will have a vote in two weeks on a constitutional amendment on abortion. A good percentage of doctors are in favor of repealing this, while in their daily praxis, they are conflicted on DNR. Or assisted ending of life. There are many in that country, who for lack of a better phrase, based on their "moral compass" as a devout "catholic" are opposed to abortion, while in their daily life, are firm believers of death with dignity. Irrespective of the referendum, people in that land, will continue to act based on their personal values. It only, allows legal decriminalized "choice" to those for whom there was none in the past.

Barring any legal impediment, your mother, and you; have sufficient legal, and ethical markers to do, what you think is best. Remove the right or wrong from the equation, for there is none.

Lest someone quote scriptures, rest be assured, for every paragraph from Scripture "A" saying go right, there will be a paragraph preaching - go left.




[As a practical matter, people who are bedridden for years, are in pain. A pain that is not communicated tangibly.]

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