For a person in moderate stage alzheimers when is it appropriate to begin withholding antibiotics, life sustaining meds and other medical practices so that that she can gracefully move toward life end. There are articles concerning end stage which make alot of sense, but since Alz. is a terminal disease there is a discussion in our family that it is time to begin implementing these same practices immediately so that the decline to the end doesn't include decline to a vegetative state. Our loved one is in a memory support unit, can follow direction, knows family on site but is having trouble with bathing, changing clothes and remembering her way. She is communicative but cannot carry on conversations easily. Her living will was signed 20 years ago and did not consider this situation. It does state if she has an incurable disease certified to be terminal in a short period of time not to artificialy prolong life. But, we also know she doesn't want to live as a vegetable. I know everyone is different, but knowing where others draw the line and why would be very helpful.
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Q: Our family is struggling to develop advanced directives for one who is in moderate stage alzheimers
Yes, everyone is different. In my opinion, a middle road is best. I wouldn't think she'd want "heroic" measures, from what you say about her living will. But certainly, if she has something that is causing her pain or distress and an antibiotic would relieve that, I believe she should have it. Each decision will be different. To me it's about comfort and quality of life.
I wouldn't suggest surgery with general anesthetics. I would suggest "fixing" something that was making her uncomfortable. My dad had skin cancers removed right up until the end, as they would have made him uncomfortable. But I wouldn't have wanted him to have major surgery, as that would have been too hard on him, and likely made his brain worse (if he survived at all).
If your mother is on blood pressure meds to prevent a stroke, they would generally continue that at this stage. Diabetics are usually given the same treatment as anyone else.
This is an ethical dilemma (which is why you are asking). You will need to talk to the doctor about your thoughts, and if you have a spiritual adviser, that would be a good place to check, too. Some of your decisions may even depend on the state in which you live.
It is very hard knowing that your loved one wouldn't have chosen this journey. I know my dad would not have. Yet, dementia is what happened, and we did our best to maintain his dignity until his body gave out. My heart goes out to you, as this is a very painful place to be.
Carol
Hi, Needs Clarification,
I agree with Carol. You didn't mention whether your loved one has another serious medical issue. In my mom's case, she had Chronic Obstructive Pulmonary Disease and had lost 80 percent of her lung function. I had one instance when I insisted that she go to the emergency room and get treatment when she suffered a lung infection; in hindsight, I maybe should have let her go. The silver lining in this is that my father was able to move to where I live (and Mom's nursing home was) and was able to somewhat come to terms with Mom's disease. (The years prior to Mom's diagnosis had been verbal warfare between the two about Mom's increasing memory loss and a negative impact on my father.) However, by the time that she suffered another lung infection, both Dad and I had pretty much come to terms with what could happen especially since she was having difficulty swallowing. She did go into the hospital for the lunch infection but upon returning to the nursing home, had a pretty steady decline for the last week of her life.
Therefore, I'd suggest that you analyze your loved one's complete health situation because there could be another health issue that will ultimately be the cause of death. Knowing that, you can better prepare for the potential issues and your responses.
Take care!
Dorian
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