Is it abuse for a Guardian to allow a dementia patient to starve without intervening?

I took my 86 year old to the doctor today, she is up to 108.6 lbs,
from the 95 lbs. she was when in assisted living,while there they have a new product for dementia/alz patients, called Axona and it is considered medical food.
it sounds awful close to the shake I described earlier. Something about ketones and how the dementia alz mind processes/doesn't process sugars.

About our discussion here, has anyone seen or understand what happens to the body and mind as it is starving? People get hallucinations, and there does come a point when the body cannot eat even if it wants to, in the end the body organs shut down, if the person loses enough weight, they have a heart attack, it is neither pleasant nor painless.

In Illinois a man died after winning the lottery, someone said the death was suspicious and they exhumed the body, maybe this is what it takes for your case to open, with your Aunt.

Also, how many children did your Aunt have? If it was more than the one did they also benefit? They did not object or is it there is only one and there was no one else?
Was the body cremated to destroy the evidence? I would think seriously, that this is something to ask your local states attorneys' office.

When I first heard your story, it was quite late, but it has bothered me tremendously,ever since. A guardian is suppose to protect the person when they no longer can, what is the difference between a family member starving a person to death or a stranger killing them some other way? Isn't it still murder?

Iwentanon...the difference in this case is that "the guardian" said the aunt told her she wanted to die and was planning to starve herself in order to achieve her goal. (sstevens seems to question that that actually happened.) If this were to become a legal matter...police, attorney & court...you know "the guardian" would explain that the aunt had expressed her desire to die. "The guardian" could even say she was protecting the aunt from those in the family who wanted to prolong her life, when the aunt didn't want that. So, it becomes an issue of...is it appropriate/right to grant ones final wish and allow someone to die when and how they wish. Is it appropriate/right not to do as they wish. Which opens the door to other questions and issues.

Who knows of this request besides the one,
if she had starved herself with food in front of her,
maybe, but it seems there might not be any documentation.
Even the guardian could have recorded her request, from her phone
we do not live in the dark ages.
No one knows, really what the Aunt wanted.
It seems like what you are saying is, that it is a moral request,between two parties, but we do not know if it was even requested.

Only on this website have I heard such a clamour
of people thinking they have a right to die.

People do not have a right to die, unless they commit suicide.

hospicepatients has an article that brings to light some important issues about assisting in the death of someone and other social issues, concerning, the end of life.

I guess what I am afraid of is that laws will be put in place to baby boomicide our generation as the largest group to put a financial drain on the community or public systems such as medicare or medic aide, and the cost would weigh more than a persons right to live.

The songs like 2525, that talked about the future, the weird movies:Solient Green and Deathrace 2000, come to mind, as fictitious as they were then, about how they would dispose of people for over-population control.

I just wouldn't want some law saying that a senior/disabled person's life isn't a 100% so lets not provide lifesaving measures...what difference will it make if we cause or let them die? Insurance companies can call it...WE DON'T COVER it.

As I said before people, that want to starve of their own free will, is one thing, the slippery slope it creates is another...

PS. I am disabled from three strokes, I am never going to be the same person, I was, and as we age are we ever the same person we used to be?

Iwentanon...I agree with everything you've said. From personal experience, both on this site and with my mother's care with some similarities of sstevens' story,
I know that there are people who feel that there comes a time to "let them go". Where and why that line is drawn can be based on a variety of reasons. And, as I noted before, can become highly controversial. I think the issue needs to be explored internally for each individual and as a culture. Stories like sstevens' and the one in the news now about the nurse at the assisted living facility who would not administer CPR for the resident who eventually died...if anything, has brought some people to ask themselves questions about their beliefs. At least, I hope so. It can be a tough balancing act to do what's best for the patient and follow personal views/beliefs, that could be varied, within the family. Someone will always lose...and unfortunately I think too often, it's the patient or senior citizen.

If I get to the point where, of my own volition, I can take a pill and end a life that has become a burden to others and a shell of my former life, please let me. Medical science has come a long way and we should be able to leave this world, by choice, without starving ourselves to death, in the same way we can end suffering for our beloved pets. In my mother's nursing home I see so many dear people in wheelchairs, unable to communicate, eat on their own, or have pleasure in their lives. No heroic measures is what both of my parents wanted- my father, when he died of pancreatic cancer, and my mom, when Alzheimer's takes her from us. I don't fear death. I fear living a life of suffering. Someday my parents will be together again, in Heaven. Not a popular opinion, I'm sure, on this board, but it's my opinion.

I think one should honor their loved one's wishes -- especially at a certain point where the person is suffering without quality of life (that is different for every person and should be respected and not judged). In many cases, as caregivers, we are simply "putting a band aid" on the situation; keeping them going -- but for what? My mom is 90 with dementia; suffering, and over the 3 yrs we've done everything from letting her be, rushing in and putting 24/7 care into place, to now just letting her be on her own as she wishes. We have chosen to stop imposing "whats best for her" and letting her wishes for "whats best for me" happen at this point. I've read several books including "A Bitter Season - Jane Gross" and they mention that the mom wanted to starve herself and she did in the end by choice. It takes awhile and it isn't pretty. A agree with DearDau that I wish there was a pill we could empower our loved one with to let them go peacefully and quickly without agony. My father was with Hospice in the end; and we were alone on a wked with all the pre-filled syringes of morphine -- I wanted so badly to just end it for him by giving him all at once; but I didn't because I was afraid of the consequences/questions. If I had to do it over; I would have just done it.

Beautifully expressed, sunflo2!! I witnessed a similar situation unfold with my mother, who kept being "saved" by medical personnel and "loving family," only to live 7 long years in misery with absolutely no quality of life. Had her wishes been honored, she would have gone quickly, with dignity, at the outset of her lengthy final illness. Your analysis demonstrates both common sense and compassion for your loved one(s).

I just talked to a friend of mine that his mom had to go to the hospital n that she didn't won't any feeding tubes in her or such. However, according to what he told me that, her dr was either going to put her n a NH or she would have to go home with a feeding tube. They couldn't afford the NH so his mom was sent home with the feeding tube n a hospital bed. Luckily, the poor woman had passed away within a month. The friend was her son n I use to work with his mom for years. So sad to hear something like this but n a way a need to know as well. She also had some other illness as well.

There are a lot of Clinical Trials going on, trying to prevent or alleviate diseases, including alz/dementia, are any of you, as involved with those, as you seem to be with ending it all?

If your loved one has this disease, the odds are in your favor that you will contract the disease yourself. The funny thing about the brain, it does it know it has that disease nor does it care. It may be naive of me, but I would still hope, that we go the route of prevention.

Sad when animals have more consideration for pain and suffering then the elderly being forced to live an empty shell with no dignity. Individuals should have the legal right to choose how they will live out their senior years when faced with deliberating diseases.

Just a side note, it is my understanding that the odds are not necessarily in your favor that you will inherit the disease. From what I have read, early onset alzheimers, before the age of 65, is more of a factor for inheritance of this disease and this comprises five percent of diagnoses.

IMO, where the questions come in...and where it can cause turmoil in families...is whether or not there has been a written or witnessed directive, when the patient/senior was lucid. If a patient has signed a document that says they do not want any assitance if medical pros have said there is no hope for improvement or recovery, I think that's pretty clear and by all means the "no assistance" wishes should be followed. The questions, and tough call for many family members comes when the patient's desires have not been clarified, leaving some to wonder what is best for the patient/senior or what the patient/senior would want. Various family members may have various ideas on what "is best" for the patient. And that is where division can occur. (and why the medical community started pushing living wells & directives) When there is no clear directive from a patient/senior, the personal opinion, desires and/or beliefs of guardians or family members can color & guide decisions, in addition to or instead of an analysis of the circumstances at hand.

sstevens in his/her initial post did not give us details about the aunt's condition. Only that she had mild dementia. But, my impression is that the aunt was not at death's door due to illness, injury or aging. (If she had signed a directive or living will, it would not have kicked-in denouncing treatment) So we are left with "the guardian" claiming the aunt wanted to die. Do we take her word for it when there were no witnesses or anything in writing? If the aunt was so convinced she wanted to die and named a guardian to make sure she was allowed to die...she wasn't willing, or wasn't asked, to sign a paper clarifying/proving her decision? Was the aunt aware of what was going on (lucid) at the time she told the guardian she wanted to die, if indeed she did? Could medications she was on have distorted reality, her thinking? Did the aunt ask questions and get answers about her future or possible treatment Did the guardian? What was the aunt's quality of life at the time? What was it expected to be in a year? Two or three years? Did anyone ask? Could the aunt have been depressed (very common in seniors)and that was influencing her reported desire to die? How did it come about that this cousin was named guardian? Could the aunt have been forced to make that decision? There are many more questions I could pose and I'm sure sstevens has asked herself. But, because of how things were handled...lack of clarity...questions and suspicions have raised their ugly heads.

If there is no conclusive directive about treatment or dying then that leaves it up to family members to make decisions. I just hope they ask questions, get answers, evaluate the overall picture for that specific person while weighing what decision to make. As each situation can be different. In making decisions on whether or not another human being lives or dies, you owe it do them to evaluate their "now & future" circumstances and not just follow through on pre-determined, perhaps long held, opinions on a procedure, treatment or response.

Thats correct Madeaa, I was also told and heard tht unless its early onset dementia/alz before 62 that we have just as much a chance of anyone else of getting this disease. My moms mom at 91 never had it, sharp as a tack, nor aunts, siblings, or anyone in the family. The only thing I can contribute Moms to is either high cholesterol or antidepressants or statins. She exercised, ate well and did everything right and at 86 got it regardless.

Iwentanon- I find your comment offensive. I have not put my mother out to pasture. She has been on namenda and aricept for many years. But you can't stop the progress of Alzheimer's. It is fatal and the end is often not pretty.

I could probably get bloodwork done to find out if I have the gene that leads to Alz, and then get into a clinical trial, but I prefer not to know. As of now, I eat healthy, exercise, and take natural preventatives (tumeric and B12). But if I develop a fatal illness that negatively impacts my quality of life with no hope for recovery, I hope to choose my own fate and go in peace.

I would hope Ya wouldn't let that happen.or anyone.

I was to take care of my aunt, she had no children and was a widow, I am an RN and this had been planned for 20 years. She had no will, poa, etc feeling the family would honor her wishes. When I went to take care of her, she had done a will, etc, but what was on the paper was not what was discussed by my aunt and myself and we tried to get things changed. My Aunt was so confused at this point, she was able to be convinced by the person appointed Guardian, that the rest of the family was trying to steal her money and a poa was granted to this person. When my aunt got even worse, we filed a Guardianship Petition since the person with the POA wasn't caring for my aunt. Unfortunately, her son is the DA in the next county, need I say any more. It was a joke, the court evaluator perjured his report, the judge refused to hear the case saying that the POA spoke for itself, etc. The appointed Guardian refused to let any other family members in the home and I never saw my aunt after the Guardianship. It took 3 months for the Order to be signed and in that time, my aunt was never taken to the MD again. According to a caregiver that was fired, my aunt was batty as a bedbug and couldn't have made an informed decision to starve herself. According to the Guardian, my aunt was so thrilled that she was appointed Guardian that she could relax and starve herself to death. This occurred on May 25th, Order was signed July 20. My Aunt never saw an MD again from May 25th until Aug 9th when i8t is noted that she weighed 67lbs. Then Hospice was called in. She died on the am of her husband's birthday exactly 32 days after the Order was signed. Once my aunt died, we were not informed of the funeral arrangements and she was cremated that afternoon. No other friends were invited to the funeral either. 3 days after the funeral, the Will appears giving everything to the Guardian. We are struggling to get criminal charges on the Guardian, but with the political connections, things are very difficult. The whole thing makes me sick, definetely to my stomach, but 100% of my heart is broken. This woman was my Godmother and she died thinking I was the scum of the earth. I know she knows now that it is false, but it killed me to hear her scream that she was so afraid of me that last day in Court. Pray that Karma prevails.

Take her out to a restaurant that serves food she loves. Order a huge meal for yourself, in front of her. Let her olfactory senses take over. Offer her a bite. Also, get her some counseling. Some states offer free home health mental counseling to low income residents. Even with the diagnosis of dementia, she may just be dealing with depression and there may be years of good life ahead for her.

Oh, sstevens, how horribly, horribly sad -and criminal. It must have been like watching an accident happen right before your eyes and not being able to do anything about it. I can only imagine how angry and upset you feel. But you did try everything to help your Aunt and that must help soothe some, I hope. As you said , your aunt now knows how wrong she was to think ill of you ( by suggestion) and how wrong-ed she was. As for the awful people who used and abused her - well, just think, they have to live with themselves. They get to be the lucky people that look in the mirror everyday and know that they harmed someone who they should have loved and who loved them. And , someday, when they are older and frailer they may just remember what transgressions they allowed happened to your aunt and then, quite frankly, I feel sorry for them.
You, ---you know how to love , you have empathy, you have a caring heart. You can rest easy in that and enjoy the person who looks back at you in the mirror.

sstevens...thanks for the additional details. You've got your hands full and it sounds like, if you continue to pursue this, the road will be bumpy and not easy. So, let me ask you something for further clarificaion...what is the "this" that you are pursuing? In other words, what do you hope to achieve...what is your goal here?

We are hoping to pursue criminal charges against the Guardian. There was no Living Will and no one but the Guardian heard my Aunt request to starve to death. The Guardian and her children also had my Aunt execute a new will leaving everything to them. I want criminal charges. In our State, there are assisted suicide laws, so I'm hoping we can get someone to listen.

ssteven, that person should be in freaking jail! I feel your pain but wander how could the guardian person can keep her own family from seeing her? So, so sorry for your loss of your Godmother n please try to remember that she was not in her right mind about having those negative feeling about you. I hope u don't take that offensively. Plus, I hope you are able to get something done n that person pays for what she done to your Godmother. You r in my prayers.

If she is not able to eat or drink, that's different! But if she is, then it's defiantely abuse if your aunt is aallowing this! Shame on her!

I would involve hospice which is provided under Medicare - this is a field that few understand and they are experts. It puts an objective third party in the mix so you would never be accused of elder abuse - most hospice folks would opt to let the person, albeit with mild dementia, run the course of their wishes. Yes, you might keep her alive longer by forcing her to eat but as her dementia increases, her quality of life be less. Most geriatrics doctors would allow a person with mild dementia to choose this course as even those with mild dementia are aware enough that the quality of life will get worse. Let the hospice people help you navigate this. Your family should not do this alone and this is one of the free things Medicare gives to all people.

To answer your question, yes.

Yes, it is abuse because the guardian has the power to order a feeding tube. The guardian has more power than they may realize and yes they can intervene. It's one thing to notice someone won't eat and not have guardianship, but it's another to have that position and watch a person starve and do nothing. No, you can't force them to eat, but you can order a feeding tube. 

As for the situation someone mentioned about a guardian and their children coercing the patient to change their will and leave everything to them, this is another form of abuse. I don't know how the person found this out, but if the patient had dementia or Alzheimer's, they can call their state bar association and ask for a lawyer who specializes in estates and related areas. You never know when you may get what's rightfully yours if the patient was not competent to make such decisions, giving someone else something they're not entitled to. That particular poster also describes what I believe to be the guardians way of allowing the person to starve to death and quicken their death so they can get everything. This makes me wonder if someone may have actually done this to my bio dad in his last few weeks of life, I can't help but suspect it and wonder