I don't know how many of you are following the situation with former DJ Casey Kasem, but it's very sad, and a good lesson for all of us to have our affairs in order before our own demise. Also, if you're a caregiver for a loved one, you should make sure they have theirs in order to avoid this sort of thing.

In a nutshell, Mr. Kasem's wife Jean seems to be a little mentally or emotionally unbalanced. There has been a major court battle recently over guardianship of Mr. Kasem, and power over his medical decisions. Turns out that Mr. Kasem set up a Power of Attorney for his daughter to make his medical decisions a long time ago. That speaks volumes to his relationship with his wife - he felt his daughter would make better decisions on his behalf than his wife, obviously. The court battle ended with the judge upholding the POA for the daughter and she took him out of his wife's home and to a hospital, where he was found to have Stage 3 Bedsores, a lung infection and a bladder infection, along with his existing blood pressure issues and Lewy Body Dementia.

Life support has been withdrawn from Mr. Kasem, based on the POA document that he has in place, which very clearly states he does not want any "heroic life-saving measures" taken, including nutrition, water, or medications if it is clear that he is mentally incapacitated and there is no possible hope of rehabilitation or recovery to a functional life. So he is no longer being fed through a tube (or otherwise), receiving fluids orally or via IV, and all medication has been withdrawn.

Some people have called this cruel, saying he's being "starved to death", because of the withdrawal of nutrition & fluids. However, if you've ever been closely involved when a loved one passed away, you already know that's not true. The human body is an incredible machine. It knows instinctively when the end is near, and that it no longer needs nutrition or fluids, and cannot process them, because the internal organs are shutting down. A dying body cannot process food and/or liquid, and forcing a dying person to accept nutrition or fluids usually causes more harm than good. In addition, Mr. Kasem's specific wishes were *not* to have food/fluids continued if it was apparent that he was dying - so his wishes are being followed. However, his wife continues to fight to have life saving measures reinstated, including tube feeding, IV fluids, and medications to support his blood pressure, etc.

The long and short of it: take care of your affairs now, while you can. Don't leave these decisions up to chance. You will not like the outcome.

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Jeanne - I've read something else recently that indicates that Mr. Kasem's wife Jean has a hard time letting anything die - including her pets. There's a story about her letting a dog live for far past what most of us would, because it had cancerous tumors and was in constant pain. If Mr. Kasem knew his wife would insist on him being maintained by machines and tube feeding when he set up his POA over 20 yrs ago, maybe that's why he made sure that specific language was in there, and why he appointed his daughter POA - not his wife. Just speculating.

Few people have such specific details in their advanced care directive. What a wonderful gift to those who have to make decisions.

Sorry, pamstegman, I should have clarified that point - he is definitely receiving comfort care, and is being medicated for comfort, but all life-supporting medicines have been withdrawn, because they are only prolonging the inevitable, and he was suffering. I think the judge made the best decision possible under the circumstances by allowing the POA to be upheld and his wishes followed to the letter.

I agree with you on the part when someone is dying can no longer accept any or little nutrition or even medicine, I have witnessed a family relative when she was passing away, she couldn’t take anything, just a bit of water with honey, the doctors said they can no longer help her, until she passed away. It was hard, but it is a part of life.
I hope for Kasem family all the best.

When you said all meds stopped, I became concerned. Researching further, I see the Judge wisely approved comfort care. Drugs like Morphine bring considerable comfort to the patient. My daughter was kept comfortable on Compazine and Morphine. On the last day she needed a little Haldol. She was alert and well-oriented and conversational until she went to sleep that night, and passed peacefully in the loving arms of friends. That is exactly as Hospice plans and it was the best it could be.

I agree, Jeanette - it's hard to say what Jean's motives are, whether it's all about control, denying him care for his infections and bedsores, opting instead to keep him home, where she can control his treatment - or if she truly cares so much that she can't bear to see him suffer. Unfortunately, the long-standing feud with Casey's children (which are not *her* children) and her recent actions seem to say that the former is true, rather than the latter. Some of the things she's said and done are way out in left field.

I will never forget the last conversation I had with my dad, in the presence of my 2nd older sister and mother. We knew he was fading fast, but his doctor felt he may still have some fight left, and wanted to put a plan in place to get him "nutritionally stable" - meaning tube feeding - move him to another hospital where he could have dialysis on a 24/7 basis and look at doing yet another surgery to replace the dialysis port, since he had serious antibiotic-resistant infection colonizing on the port (and in his blood, his bladder, his lungs....). Based on the doctor's plan, we agreed that we should discuss further treatment with Dad, and see if that's what he really wanted to do. We all went into his hospital room in the ICU and awakened him gently, making sure he was lucid enough to understand us. I asked him if he wanted to continue to fight, and explained (in simple terms) the doctor's plan - or if he wanted to stop dialysis and all other treatment and let go. I still choke on those words, even just saying them in my mind. He was silent for a moment, so I repeated my question. He opened his eyes and looked at me, so sadly, with those faded blue eyes, and said, "I don't know what to do....I don't know what to do." We all hugged him and told him if he wanted to let go, it was ok...that we all understood how hard he had fought for the past 6 months, and that if he was tired of fighting and just wanted to go, that was ok - but we needed to know what he wanted. Did he want to go, or stay and fight? He opened his eyes again, just for a moment, and said, "Stay." - and then drifted back to sleep. We advised the doctor and left the hospital and headed home, thinking that we were going ahead with the doctor's plan to move Dad, start almost constant dialysis, and try to get him more nutritionally stable. 2 hours later, the hospital called and said he was leaving us. We made it back before he passed but he was already unconscious at that time, and never woke up again. I was so glad we had that conversation with him - I think that even though he said he wanted to stay, our giving him permission to go was what he needed to be able to let go.

I had the same conversation with my grandmother (my mom's mother) when she passed...telling her it was ok to go if she needed to, but I hoped she would wait until my mother got there to say goodbye. My mom made it first, and told her it was ok to go if she wanted, and said goodbye....and within seconds, she was gone.

Sometimes, we just need permission to let go. Loved ones fighting over how the final days are handled only makes the inevitable more difficult for everyone involved, including the one that is passing away. We don't know what a dying person can still hear or feel - what if Mr. Kasem could still hear all the bickering and arguing that went on during his removal from his wife's home? Why would you want to do that to someone in their final hours or days if their last wishes are clear?

Excellent article Susan!!

The hardest part of watching someone die is abiding by their wishes to let nature take it's course. My romantic side hopes Jean Kasem couldn't bare the thought of her beloved husband not being there... still not good choices she made.

I will forever be haunted by my dad's eyes in the ER when they finally found the giant mass in his one remaining kidney. His eyes pleaded to me to take him home. I did. Less than a week later he passed. They know when it's time.

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