Sunday April 20, 2014
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Lolly and I both have filed our wishes with PRMC. We have each filed a Do Not Resuscitate statement saying when we wish to end it all. Not doing so is foolish. Someone may keep you alive for his own reasons.
In 1994, the U.S. Supreme Court ruled that patients who are dying and in pain have the legal right to be prescribed medications "to alleviate that suffering, even to the point of causing unconsciousness and hastening death."
Life is the most precious of all gifts; it the most fundamental of all the things you will ever own, but isn't it your property? Or is it the property of some doctor or lawyer?
Isn't being able to sign a DNR a recognition of the right of an individual to decide when to end his life? Isn't that Supreme Court decision an affirmation of that right?
Consider this case:
At home in Schuylkill County, Pennsylvania, Joseph Yourshaw, was dying a lingering death of end-stage diabetes and heart problems. He reached the stage where he could no longer stand the pain, and told his daughter Barbara that he wanted to end it all. Barbara, a nurse, is accused of placing a bottle of morphine where her 93-year-old father could get it and leaving the house.
A hospice nurse making a routine call arrived some time later and found Yourshaw. In direct violation of his Do Not Resuscitate order, she called 911.
Yourshaw awoke in a hospital, angry at being there when he had chosen to spend his remaining days at home, and even more angry at being alive after making the most difficult of all decisions.
Yourshaw died of natural causes just four days later. Local law enforcement officials refused to act, but Pennsylvania Attorney General Kathleen Kane has chosen to charge Barbara Yourshaw with a crime.
Barbara's lawyer, Frederick Fanelli, is unable to comment on the case because Attorney General Kane has obtained a gag order. The reason is obvious. The question the trial will ask is one of fundamental rights that lawyer Kane does not want discussed in public.
Fanelli lost a case in lower court filed on the belief that Yourshaw had a constitutional right to take enough medicine to ease his pain. That case will be appealed. How it will be decided is as yet unknown. I'll let you know when something happens.
Since this since this involves a matter of fundamental rights, and no one knows better than you do what you believe your rights to be, I'll ask you a couple of questions.
Do you feel that the government has the right to try you for a crime, or to lock you up in some padded room, if you come to the decision that your life is no longer worth living, and you decide to end it?
Is there any real difference between signing a Do Not Resuscitate statement and any other decision made that it is time to end your own life? Does a doctor, lawyer, or legislator have a greater right to make that decision than you do?
Because this is one of the most fundamental of all questions, I'll ask it again.
Who has the right to say when it is time to pull the plug? You, or someone else?
Have you signed a DNC yet?
Tom, when I was in my early 30's, my Aunt was in an accident and suffered a great deal at the hands of doctors that had to have known what the ultimate conclusion would be. I went to a lawyer and got all the paper work completed because MY thought is: when God decides it's time for ME to go, I don't want anyone to interfere with that process - no doctors, no family- nothing. Don't even plug me into anything that is Life-suffering-prolonging. I've decided that God decides. :-) Great points you bring up. Thank you, Jane
Jane, you are more than welcome. This is not an easy subject to talk about, especially when you get to my age and have a beloved wife who means more to you than life itself, and who is very, very ill. But I advise anyone who has not yet done it to seriously look at the choices on a DNR statement and make up his or her own mind instead of letting someone else do it at a time when it is too late.
I'll say it again: The greatest right we each have is the right to life. All other rights pale to insignificance beside that most fundamental right of all. By any and all logic, the flip side of that coin is the right to decide when life is over. Any law, any system, any program, anything which does not come from the possessor of that right is just plain wrong.
That is not to say that when someone is in trouble and in a situation that cries out for a helping, caring hand that we should not extend one. But the final decision is between an individual and his or her Maker.
My husband and I did a Trust and all the papers for our last wishes. Pages and pages of them if you do it right.
Durable Health Care Power Of Attorney is very important. I have a copy of the power of attorney in my purse, in my trust book and the one that has power of attorney has a copy.
To carry this a little farther, when we knew my husband would never come out of his so called medical care two of my kids and I went to Messingers and had my husband and my funeral arrangements made, picked out the caskets and all is paid for. About the only thing that has to be added is date of death. I did not want my kids to have to go thru that. I did it alone for my mother when I was 20, it was terrible. It is hard enough to lose a loved one without having to make serious decisions and remember everything you need to know in a few days time.
My hat goes off to you for your wisdom and foresight.
Hard subject. Not pleasant. But ignoring it doesn't help.
Death and paying taxes are the two things we all have to go thru.
Be prepared as you can be. No one is really prepared for death but it will come and what you may leave will be taxed.
Yes. Life is taxing.
I believe that you are asking a very personal question that cannot be answered by anyone except the person who is directly involved i.e. the sick, dying person. I also believe that we who are not directly involved (bystanders to the sick dying person) should accept and respect whatever decision the sick, dying person makes. Let's not judge.
In the case that Tom mentioned. The dying, sick person made the decision to take the morphine. Even if the bottle was within reach, he could have left it just where it was placed.
On something possibly related. In a book I was reading a mother was taking it upon herself to clean up a very messy house of a elderly neighbor. She was insisting that her teenage daughter accompany her on this mission. Typically the teenager asked, "If she chooses to live in her mess, what right do we have to come and clean it up?" At what point does doing good simply become an imposition of your standards or beliefs on someone else?
Bernice, as to the part about cleaning the elderly ladies house, maybe she wasn't able to clean it and it was a bratty teenager that didn't keep her own room clean.
There is a higher power that decides when your life here on earth is over.
You or a judge, dr. or anyone else does not make that decision.
Think of the people that have tried to commit suicide and failed.
Pills may or may not ease your pain but if it isn't your time, something will happen to keep them from killing you with a so called overdose. Think of people you know that have died from freak accidents. The papers you sign may keep you from suffering, but there is no guarantee you will die at the time of your choice.
"I believe that you are asking a very personal question that cannot be answered by anyone except the person who is directly involved i.e. the sick, dying person. I also believe that we who are not directly involved (bystanders to the sick dying person) should accept and respect whatever decision the sick, dying person makes. Let's not judge."
Well said, Bernice
"Typically the teenager asked, "If she chooses to live in her mess, what right do we have to come and clean it up?" At what point does doing good simply become an imposition of your standards or beliefs on someone else?"
One of the prime questions of our times, and of former times too.
Pat, answered one question which is slightly off the subject, but is an obvious one that comes up: Namely the motivation of the teenager. Hard to say why she might not have wanted to do anything, but since teens rarely think very far into anything it's likely she was irritated at having to give up her time for someone else. Who knows?
But the second question? Is it a "choice" of the elderly person? Well, there are choices and there are choices. Some of them are forced upon us because doing anything else is beyond us. If that's the case, then the help is not only well deserved, but it is something that rewards the giver as well.
As to the main question, when are we intruding because our "help" is actually a means of control? That's a hard one when it comes to you or I giving help as an individual; only someone seeing the actual case can reasonably draw the line.
But if you and I get together and impose our standards on someone else then it is a clear cut intrusion. That's one reason people are so unhappy with the government at the moment. People like His Majesty Bloomberg try to force their opinions upon others. And then some very shallow thinkers rationalize what he and others are doing by saying that it is "for the good" of the people they are oppressing. Some people genuinely think they are helping; they are wrong, of course, but they do feel that way. Some people begin to to use statistics to justify their positions, saying "look at these numbers." There's a simple answer to that one: The person who is being over-controlled can read those numbers too, and if he or she prefers to ignore them, that's that. And then there is the cost to the economy which is also used to rationalize such positions; that too has holes in it since there is rarely a case when what you do to yourself should be stopped because it costs too much to bury you (or whatever).
Pat, your viewpoint is eminently practical. Look at the poor guy who signed a DNR and found himself awake in a hospital because some nurse undid all the trouble he had gone to in an attempt to make sure that he "died with dignity."
Anybody want to take a shot at what her motives might have been. I can easily see four of them; two of them quite acceptable — and two others....
DNR can mean different things to different people under different circumstances.
If you fill out the long form it covers everything and some of the questions are the same for different circumstances. Read it carefully before making any check marks. It is best if you have someone with you, better yet the one with the Health Power of Attorney.
Also if you have done your paperwork and wishes are known there is no family disagreements and hard feelings later because you made the decision.
They may be mad at you, but what can they do about it? (:
Had to lighten up a little.
Pat is correct about DNR can mean different things to different people. You should be sure you understand everything before you sign the form.
As I understand the purpose of hospice is only to make you comfortable as you quietly exit. I am surprised that the hospice nurse called 911.
What exactly does hospice do? Do you continue your life prolonging medicines, i.e. blood pressure, insulin, etc.?
They did nothing for my husband but furnish blue pads to put under him on the bed and gave him a shower once or twice a week at Powell House. Sent one person to do it so I had to pay Powell House extra for one of their employees to help them.The dr. was there one time in all the months he was at Powell house. Then tried to throw him out on a Friday. Said he no longer fit the criteria. Could not straighten out in bed, feed himself, talk or know anyone. Was that way when they took him. But Hospice said they were through with him. I wasn't paying them $4 or $5000 a month so didn't want to take care of him. Don't why they took him as a patient in the first place.
Powell House was wonderful to him. But couldn't keep him after Hospice wouldn't have a Dr. covering him.
Hospice may be different if the patient is in their building.
When I moved him to Mesa and he was with Sun Valley Hospice in a private nursing home they gave him wonderful care. 15 minutes after he arrived the head nurse and 2 drs were there to check him and someone from Hospice was there at least 4 times a week to check on him and do what was needed.
Bernice, Hospice Nurses were like angels to my father that suffered from ALS. No, they don't prolong life, they make life as comfortable as possible under the circumstances. This included educating us (family members) on what to expect. My father had a DNR. The day he died, we were there with the Priest that gave him a beautiful send off, and while the process of dying may appear to be without pain, I feel that he was in substantial pain so a good supply of morphine was there (which was immediately documented and disposed of when he died). Hospice of the Valley is incredible with compassionate and wonderful people. I believe they helped my dad come to terms with his illness, and prepare him.
Good advice, Pat.
I first started thinking about elder law when Lolly and I went for our social security briefing when we were retiring. I had never even heard the phrase, but when I realized that there had to be a body special law regarding the elderly, just as there are for school children, I began looking into it.
There's a place I go regularly, one I read to see if there is anything I should pass on to you folks. Here's a link:
"As I understand the purpose of hospice is only to make you comfortable as you quietly exit. I am surprised that the hospice nurse called 911."
As far as I know, Bernice, that is the purpose of hospice. I know, because a hospice doctor whose name I will not mention told me, that medicare expects your stay there to be no more than six months. Right out of the blue several years ago, I go a call from his office one day saying he wanted to come see Lolly. Since he had once been our doctor I thought he was just doing something nice. He arrived, talked for an hour and half, said nothing, and gave me two prescriptions: One for methadone, which is not allowed by the company which manufactures it to be prescribed for anything except a replacement for heroin, and haldol, which is a chemical restraint for violent patients. When I looked at them and saw what they were I would have wrung his neck if the laws were written right. They would no doubt have ensured that Lolly met the Medicare six month requirement — seven years ago.
Thanks, Jane. Not an easy subject to discuss.
As I understand it, hospice care is only available to patients who have been diagnosed by their doctor as terminally ill and likely to pass away in a short time, perhaps 6 months as Tom says.
Jane, Are you able to continue with the same doctor(s) as before your diagnosis or are you only able to receive care from hospice doctors. Also, I believe that if you are getting hospice care in your home, there is no charge to you, Medicare or whatever insurance you have picks up the tab. Is that true? Thanks for sharing your experience.
I have no idea about the insurance coverage, Bernice - this happened 15 years ago, and the same doctors would be neurologists that aren't really considered "family doctors". I believe that my parents paid for in home health care from an agency, and Hospice came in about a year prior to my father's death. I know he reached 70, but as far as insurance coverage, I'd have to consult with my mother.
That Hospice nurse that called 911 would be sued by me.
Tom, God bless your Lolly. She's a real trooper and a fighter, and obviously wants to stick around. Perhaps your doctor thought he was doing you a favor, and didn't realize that some people are willing, able and WANT to take care of their loved ones & by no means consider them a "burden".
Tom, you brought up a good point. Mistakes can be made concerning the exact time of death. Perhaps that doctor made a mistake in not fully explaining his intention when writing out the prescription. Perhaps he should have made it clear that they should be used only in the case of extreme pain, etc.
Bernice, as Pat says there are a lot of details in all this, and it pays to try to find out all you can. I guess that's about all I can say about it. Beyond that I would be talking about something I know nothing about.
Jane, an odd thing happened during our wedding ceremony — in Saint Patrick's Cathedral in Karachi, Pakistan, of all the unlikely places. I was a drill instructor in my younger days and had a voice which, although quiet enough when I was having a normal conversation, perhaps even quieter than most, could drill troops on a drill field when they were way off in the distance. You practice that as a drill instructor, not being loud so you can yell at the troops as they do in the movies, which is stupid and unnecessary, but loud enough and clear enough so that when eight or ten drill instructors are drilling their troops on the same field, or marching their men along the side of a road among traffic, they are always in control of what could become a dangerous situation.
Lolly and I were saying our wedding vows. The priest looked at me and said, "Do you, Thomas, take Loretta to be your lawfully wedded wife, to have and to hold, from this day forward, for better, for worse, for richer, for poorer, in sickness and in health, until death do you part?"
I didn't say, "I do." I said, "I DO!!"
My brother in law Pete, who was my best man, told me afterward that a ripple of comment went through the church.
Why did I say it so loud and clear? I do not know, but at that moment I felt a sudden surge of emotion, something that made it important for me to say what I felt, and what those words were saying is what I felt!
I meant those words. I still do, and always will. If it had been me who got sick, I know that Lolly would have done the same thing that I am doing. As far as I am concerned the only reason I am here on this earth is to take care of her. For better, for worse, for richer, for poorer, in sickness and in health, until death do us part.
And hopefully, not then either.
And for anyone who's a little younger and wants to know, doing it is the easiest thing you will ever do.
Tom, it's not often that I read something that moves me to tears, reminds me that each day is a gift, and to count my blessings. Thank you for sharing this.
As most know I lost my wife of 47 years after her struggle with cancer over a 6 year period. She took her last breath at Hospice Compassus in Payson. Those folks were magnificent. In reflection I think those 6 years made me a better person . After a career helping people resolve some out of the ordinary situations in their lives, I found myself totally helpless to do anything about her cancer. All I could do is what you are doing for Lolly, honor those vows taken so many years prior. It's called putting others ahead of yourself. I have since remarried to a woman who likewise lost her husband through a heart issue. Both of us, having gone through the experience we did as caregivers, know that every day God gives us is a gift and we are intent on making sure we acknowledge that fact. I have been so blessed in my life that I often feel guilty for my circumstance.
"I have been so blessed in my life that I often feel guilty for my circumstance."
I know the feeing. At times I consider myself to be the luckiest man alive.
And I sincerely meant what I said when I said that it was dead easy to honor your vows. Doing anything else is what would be hard. The odd thing about giving of yourself is that the reward so outweighs the giving that you are exactly right — it almost feels guilty.
Over the past few days I have discovered the life of a woman called Bertha Vester. I read a few words about her in the autobiography of Lowell Thomas who, in case anyone is too young to remember him, was a well known radio announcer. I can hardly wait to tell her tale, although I think I will write it in advance and send it in as the column that falls just before Christmas; it is so beautifully fitting.
Hope I'm still around to read it. :-)
Tom, I hope you are around to write it so that we can read it. :-)
That would kinda sorta please me too. :-)
Finished the last of my research of Bertha Vester last night. The woman was a saint. I'll start writing the column today. I always work eight weeks in advance, so it will be a while, but the timing will be perfect for Christmas.
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