Thursday, February 04, 2010

The Dilemma of Death

I have a parishioner who is in the last stage of his life and had a crisis recently that sent him to the hospital, frail, medically very fragile, unable to convey his wishes very coherently because of his terminal disease, and with all the necessary steps taken to use Washington's Death with Dignity act, when and if he chooses to.

He came into the hospital with a major infection and, though he is also a hospice client, the hospital is duty-bound to treat his medical condition aggressively, with pain meds and antibiotics. I don't disagree with this because I know the hospital has its protocols for prolonging life, even when they might sympathize that the kindest thing to do might be to let his condition run its course and not prolong his life.

His family is farflung and the congregation has been supporting him, with rides to church, visits, special foods, companionship, and I've offered pastoral care during the past almost-year that he's been with us. During this time, the local hospice staff has also provided nursing and spiritual care.

So a few of us have been with him over the past two days, until his family members could arrive; one friend stayed a night with him, when he was at his lowest ebb, and I came to relieve her the next morning, staying 5 or 6 hours myself, until family members could get there.

During the time while we were waiting, the hospice chaplain and I and others considered what his options are and what protocols we must offer, as supporters but not directors of his care. And it pretty much came down to "what he wants and is able to communicate is what we will do". My ethics and those of the others considering the issue are in line with this dictum.

However (and there's always a however, isn't there?), though I doubt this man has ever "lost a marble" in his life, it's hard to know just how much he understands and how accurately he is communicating to us. Hand gestures are indeterminate sometimes; nods and shakes of the head are easy to misinterpret; words are not possible---he isn't strong enough to write anything and can no longer talk intelligibly.

So we are in the limbo of indecision. Whether he will use the meds to end his life, whether he will allow himself to be cared for in a physical hospice setting (where they don't permit clients to use the DWD act because of liability and other concerns), whether he will die of his illness before any of this can happen---all these options (and probably others I haven't thought of) are on the table. He probably will remain in the hospital until the infection can be controlled, perhaps another several days. This will make him much stronger and able to live longer, but what will his actual quality of life be?

We are all agreed that it is unlikely that he can manage at home unless he has constant care and his home is very very small, too small to allow for a live-in caretaker. If he decides he wants to go home and live alone again----there's the unanswerable question. Even family members can't easily make that decision for him without declaring him incompetent to make those decisions.

Families deal with this so often, at the time of a loved one's impending death. And I can't help but wonder, as I watch them and help them deal with it, what it will be like 20plus years from now when I might be in the same predicament. Or rather when the Favorite Son will be in the predicament along with whoever his pastor is at that time.

FS, are you listening? I hope so. It may be over 20 years away, but it'll probably happen to us too. You might consider quitting any life-threatening habits you have so that it's not me and your spouse and kids making the decision about you! Just sayin'.

UPDATE: In talking with family members, I have learned that our friend is resting peacefully, in no pain, receiving no extraordinary measures, and will drift away with family at his bedside. No more interventions to give him pain or prolong misery, which is what we all hope for, a good death. Thank you, God, Goddess, the powers that be.

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