The DNR decision?

((((((tiny))))) judgement from family rings true in my ears. My experience is that I am d*mned if I do and d*mned of I don't, so I make the best decision I can and stay away from them. My sis is my biggest critic, despite doing nothing to help mother. I have decided not to tell her and her family the details of what continuing care means i.e. not to tell her that means no antibiotics if mother gets an infection. When asked I gave a very general description of comfort care and suggested they look it up on the internet. I am sure on principle sis would, from afar, and not having seen mother for over a year, disagree with my decision whatever it was and try to make life unpleasant and difficult for me, so I am sharing little and in as general terms as possible. I have stated that it is the doctor's recommendation - which is true - but did not state that they asked me and I agreed with the recommendation. I left out details other than those which seemed harmless - like them stopping mother's herbal supplements as they are not doing her any good any more. Less is better when it comes to sharing with those who are judgemental. Look after yourself. I know it is a shock to get to the point where there is nothing that can be done to improve the situation, just try to ease the person's daily life and eventual passing.

@rainmom -re feeding tubes - the evidence is that feeding tubes at end of life bring more problems than they solve unless it is for a specific issue for a short period of time. As the body shuts down the individual cannot process food - it really is not starvation, but part of the process of dying.

Tinyblu, regarding telling family - I can only say what I would do, and yes - my family has its fair share of a-holes. I would probably only tell them if I thought some good would come of it. It's a safe bet if you tell one soon everyone will know so when accessing any good outcomes you'll have to weigh it with the possibility of a bad outcome as well. Are there fences that could be mended before your father passes, positive things that may need to be said? Would your father welcome additional involvement and attention from the family? When I had my mother placed on hospice I told one brother but not the other. I figured the one I didn't tell really wouldn't care - he basically has no relationship with my mom and isn't looking to fix that. Plus I figure he will find out sooner or later and won't care that I didn't involve him. The brother I told would have had kittens if I made this move without talking to him so I told him to save myself some drama in the end. If your dads able, let him make the decision as to who he wants to know what. If dads not and its up to you - take some time to think it through, weighing the pros and cons. Tough spot your in - maybe find someone who knows you, knows your family and bounce some thoughts off them for an outside opinion.

Tinyblu's father is not able to do his advance directives now, judging from what was written. Tinyblu, did he set up a healthcare POA (medical proxy?).

I have a feeling that when it comes time, then you will know what to do. It will be difficult, but you will know. I hope that your father does not suffer greatly with the cancer. Don't blame him. Many people got hooked at a time smoking was considered cool and weren't able to get unhooked fast enough to prevent illness. I wish we could go back and talk to Native Americans and Sir Walter Raleigh about the harm they were doing. I hope one day there will be no tobacco.

Thanks so much everyone. I have often cursed modern medicine for the prolonging quantity of life over quality. I know I don't have to decide today, and I did speak with the owner of his adult day care center who gave me sound advice.

The family is going to judge my decisions no matter what, and considering that I've been with him throughout this ordeal and I have full POA, I will make the right decision.

And... the doctors aren't sure if the mass is cancerous, but the biopsy process alone on such diseased lungs would be very invasive for Daddy. The doctor basically suggested giving Daddy an oxygen tank to help him breathe (yet another gut wrenching matter) and simply CT scan him every three months until the end.

I think the doctor was asking for the directive because he anticipates it getting pretty ugly from here.

There's a part of me that the Daddy could just peacefully sleep away vs. being attached to oxygen tanks and coughing and wheezing.

Next question: Do I even tell the judgemental A-holes in my family what's going on?

Yes, good discussion. As I've stated in the past my mother has a very long, very detailed, very strict Advanced Directive - it barely allows for her to be picked up off the floor and made more comfortable in a bed. It's so strict that several months ago her doctors approached me for authorization to give her an antibiotic for a UTI - the hospital has her AD on file. I did say yes to the antibiotic as when it comes to a UTI I do view it as a comfort measure. I disagree with one part of moms AD - a feeding tube. I don't see a feeding tube as an extream measure if that is the primary issue as I don't think anyone should be starved to death. However, my mom feels differently and when I signed off on her AD I knew I was signing off to follow her wishes and beliefs, not my own. Just recently it became time to get hospice involved in my mothers care. The hospice doc and I went over every rx my mom was taking one by one and we agreed to stop everything but what I call "mood enhancers" - Ativan and antidepressants and also pain meds. While I did this with a heavy heart I did this without guilt or doubt. These are my mothers wishes and letting her life end naturally but without pain and anxiety is the most compassionate thing I will ever do for her.

You would be making a decision for your father's welfare, what he would want, and just as importantly, what's the best decision for him under the circumstances. It may be the most important decision you'll make for him.

The next time you and he see the treating physician, ask what the anticipated progression is, what are the circumstances and symptoms that indicate death is close, or what are the same elements that indicate death is not that close but that the quality of life will not be tolerable.

Discuss these situations with your father and agree on some definable measures at which he would not want his life prolonged.

If you really don't want this responsibility, as you state, then ask your father who else could handle it for him. Given the family situation your mention, perhaps it would be better to ask one of your father's close friends, or even a minister.

But don't resent the responsibility and don't take it if you don't want it. Ask his pulmonary or other doctor if there are medical professionals who can make these decisions for you when the time comes. There could be a conflict of interest from a treating physician, so this could be an iffy proposition.

The alternate way is to recognize that you do resent your father's having smoked during his life, that it wasn't a wise decision, but that you have limited time with him now so focus on those aspects of your father's personality that you do still love.

Let go of the anger and feel sadness that he made poor decisions in his life, and focus on the fact that the difficult decision you make could relieve him of further suffering. That's the really important factor in this issue.

Tacy022 is right. You are not playing god or murdering your father if you choose DNR. I faced this when my father died. I looked at the face of the man who raised me and with deep grief said no more suffering. At some point, medical intervention is just that... prolonging the agony with inflicted agony. Let nature take its course. You might second guess yourself. I did. But over the years as i have seen more, i know i did the right thing and what i would wish for myself.

Tacy and Sorry, very well said.........

Perhaps forcing treatment on him is playing God. Maybe this is Gods way of allowing his life to come to an end. Letting nature take its course is much more compassionate in my book.

Good discussion. A couple of points:

When we are looking at this decision for an elder ask what you would want done if our situations were reversed. No one wants to play god but we drag life out far, far too long in most cases.

Nothing has had the impact on extending life like modern medicene. It's just nuts. Nursing homes are full of miserable old people who should have passed on long ago. Why do we do this. You can find 25 kids in any neighborhood with no insurance or medical care but we're keeping granny alive for another 6 months via heroic measures and at great expense. Oh yea, I know, death panels........Sign me up.

Even though I had to face something similar when my mom passed last month, my mom did have an advanced directive, living will, DPOA, health care proxy etc. set out. Still, even know that she had already made the decision myself...the act of carrying out this directive and signing on the line to remove the breathing tube was literally the most difficult thing I ever did. Even though I know, logically, that it's what she wanted, and even though I have the legal paperwork, it did not make the decision any easier, and I still feel horrible guilt every single day. I question the decision, wondering if she could have recovered (even though I know she never would have) etc. etc. What you are facing would not be any easier even if you had all the paperwork. And I can tell you (since I'm not you) to have peace with whatever decision you make...I still don't have it myself and the paperwork didn't make it easier. I have had to put down my beloved pets, and obviously they had no directives, but I was able to know in my heart that I was ending their suffering and helping them make a peaceful transition...but with my mom I can't feel the same. I know i SHOULD, but I can't.

My best advice is to talk to his doctors, and when the decision comes, ask them their opinion, to solidify your choice. This will help some, and this did help me some in the moment of the decision.

Angel

Hi Tiny - ((((((hugs))))) such a difficult position to be put in. I understand about not being able to discuss things with family and about how it feels - and is - such a huge responsibility.

While your dad was of sound mind earlier in his life did he ever give any sense of how he viewed these matters - for himself or for others?

I have just agreed to comfort care for my mother -which means no antibiotics if she gets an infection, reducing her meds to the basics and no interventions except that which would keep her comfortable. So I am in a similar situation though she has always indicated that she did not want extraordinary measures at the end of her life and she did sign a DNR.

It does seem like too big a decision to shoulder, yet the doctor who I discussed this with yesterday made the recommendation and I agreed to it. I rest in that the doctor is a specialist in this area and has much experience. As we approach the end of life there can come a time when there are no good answers in terms of quality of life - just better or worse ones. I don't want to see my mother linger as she is and I don't think she would want that either. To me it sounds like your dad does not have many options as treatment for cancer - if that is what the mass - is very hard in a person and the success rate is not high for lung cancer.

You are a very concerned and responsible daughter, going through some of the toughest stuff life hands us. As others have said - you know your dad best. Is there some one related to his care you can talk this over with? Keep coming back here with your feelings and any questions. Even though I know I made the right decision for mother, it still does not feel comfortable. We made the decision to take our youngest son off ventilation. That was the hardest decision I have ever made. We put him in God's hands and that was the only way we could have any peace about it and accept the outcome. More ((((((hugs)))))).

A large percentage of people choose to be a DNR. They make that choice when they're of sound mind. An elderly person being resuscitated is not a pretty picture and can be quite violent. Often ribs are broken, the chest is injured. The person can come back only to be put on a ventilator and the family has to decide at some point to turn off the vent.

In letting the disease process take over there are medications available to make the person more comfortable. The person may or may not be conscious. Hospice can be called in to make things easier on the family.

You are not a murderer. You are not killing your father. You have a choice to make. And once you make that choice there will come a time when you second guess your choice but stick to what you decide. Make a thoughtful, well-informed decision when you're not emotional and go with that decision. Your dad is going to pass away at some point whichever way you choose so you can't choose wrong.

I had to make this decision for my father during his final week. It was not difficult for me, because I knew his body was too sick to go on and that he was ready to cross over. The nurse explained to me what could happen if CPR was done on an older frail body. I knew my father would not have wanted that. Fortunately, he had signed a DNR and I just had to affirm that it is what was wanted. If he had been brought back, it wouldn't have been for long. He was too sick. There would just be more suffering.

I've had to face just this situation with my mom a few weeks ago. She had a heart attack on top of an already weak heart. Long story short after two ER and hospital stays and rehab in between the docs couldn't find the right combo of meds that would strengthen her heart without compromising her blood pressure and kidneys. Though I had to push them to try in the first place and I believe they did, her body has too much damage. In the midst of all of that I had to deal with the DNR, AD stuff. She never dealt with it, neither has dad. So seeing her struggle I made the call to do the DNR.

It was very hard and not it's fair. Like you my brother is MIA and my dad has his own issues so it's on me like it or not. But I love her enough not to put her through any more turmoil than what she has already withstood. She started hospice yesterday and it's gut wrenching to go through this when she was walking the treadmill like a sport just three weeks ago.

You have to search your heart and you know your dad best. I struggled with all the same things too or many of them I'm sure. But after all I've seen with her, I prayed and said Lord I'm doing what I think is best. After all she's your child and now this is between you two. I am still there supporting her though and making sure to the best of my ability she has the best care possible.

You are no murderer. If you were you wouldn't be here in the first place telling us your struggle. Sounds like you are a loving, responsible daughter having to do some really hard grown up stuff and become the parent right now. You will make the right decision. Just know I'm right there with you facing it now, just like you.