Ethics and The End

Late afternoon Thursday, we finally got all the ducks in a row to start hospice care for my Mom. The final step was the signed order from the doctor being placed in my eager hands... or so I thought. Then he wanted to chat.

In a way, I think he was trying to prepare me for these final days but I kind of have mixed feelings about some of what he had to say. He talked about the goal of hospice is to provide comfort rather to solve a medical issue. And here's where our disconnect began... apparently rather than dress wounds and give antibiotics the answer is now to provide pain medication. Lots of it. More than is probably needed to simply address the pain because a slight overdose of pain medication makes a person more sleepy and less hungry and thirsty. With less intake of food and water, less nutrition, the vital organs shut down faster and they die sooner. He said, in simplest of terms, that the goal now becomes to medicate her to death.

He did acknowledge that medical ethicists have issues with this kind of care... that it's kind of a gray area of medicine. At the same time he affirmed repeatedly that the goal is to die faster and in comfort. He also said this gray area is what drew many doctors, including him, to a practice in geriatrics.

And when the hospice nurse came to do the intake assessment, the first thing she did was order what they call an E-pack. It has 4 vials of liquid medication to be dispensed as drops under the tongue. The first one she talked about was morphine. (And yes, I'm a little freaked to have a vial of morphine in my house!)

When a person is in pain, I'm all for giving an appropriate dose of pain medication to bring relief and comfort. Where I have problems with this approach is in purposely giving just a little to much with the intended purpose of hastening death.

How is this not murder? Where do the ethics really lie here? Am I crazy to question it rather than trusting what the doctor says?

If I were to give an honest assessment of what's really wrong I have to admit my Mom has a lot of problems. Historically she has had a major heart attack, bowel cancer, gall bladder problems, 2 broken hips, osteoporosis, and advanced dementia. In recent months she's had less and less interest in eating and has lost a lot of weight. With the nutritional deficiencies she's got contracture in both knees and edema in both lower legs. And she's got some awful bed sores. However, she will eat and drink and is alert much of the day. Well, not so much today after the hospice nurse ordered her to bed yesterday. The bed sores I've been able to care for are healing. The pain she expresses seems to come and go quickly is appears fairly well controlled with the occasional ibuprofen. And surprisingly, considering all this talk of offing her quickly, the lab results for the blood draw at the doctor's office is very very normal and healthy.

I am so unsure of what I think and feel right now.