Why does Hospice sound like assisted suicide?

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My mom and I met with the hospice case manager yesterday, and Hospice sounds like assisted suicide to me. Mom has congestive heart failure (she just told me that yesterday) end stage of COPD, asthma, cronic asperated pnemonia, panic attacks, etc, so we meet with the Hospice case manager, at the encouragement of Moms hopsital case manager. And they want her to be a DNR, and if she has trouble breathing then they will help her work thru it. If she gets to the point she cannot breathe, don't call 911, but for ME to administer the meds... are they serious !!!! So let me understand this... Mom can't breathe, so I am supposed to be ok with giving her a medication that will relax her so she can stop breathing...? ! ? I don't think I'm ok with this at all.
Everyone said "oh hospice is just wonderful." What I see is assisted suicide, and everyone else standing on the other side of the fence saying oh look, she has hospice, her daughter will be so supported we don't need to do anything to hel[ now...

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If you are not OK with hospice, you certainly do not have to accept it. It is totally optional. Please do not feel intimidated to use it.

People who do accept it generally accept that their loved one is at the end of life's journey. They believe that the outcome will be death, relatively soon. With medical advice, they believe that there is no cure for their loved one's condition, and no way to regain a quality of life. They do not want to prolong their loved one's suffering. They want the inevitable end we all share, death, to come naturally but also while providing comfort and reducing pain. They want help for themselves in understanding the process of dying, to help them accept the end.

What was your mom's reaction to the meeting with Hospice? Many people try to honor their loved one's wishes, whether it matches their own preference or not. Is your mother able to comprehend what was discussed? Did she express her preferences?

Like many people, I do not think of a DNR order as a wish to die. I do not think of death without medical intervention as suicide. You have every right to your own views and to make your own decisions, along with your mother. I hope you will not judge others harshly if they have other views.

I wish you peace with whatever decision you make. May you have strength as you face what lies ahead.
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Morphine may actually ease breathing as well as pain - it will relieve congestion casued by pulmonary edema (fluid/pressure build-up in the lungs) so it may be ethcially very much OK to give it to make the actual dying part less awful, even if it makes that part shorter too. But that said, if you are not comfortable with that part then it would be right to have a nurse there instead or just because this is all very hard on caregivers to face death so directly. My mom had a bad heart attack in inpatient hospice that took her away - they gave morphine, which she absolutely needed as she was having classic, crushing chest pain for the first time ever... no one thought that was going to be it, though, and they left just her and me in the room - then her breathing changed and I sudenly realized this was it. I pushed the call button again, but no way was I going to leave the room to drag someone back in more immediately than they otherwise would have/should have come. I was glad I was there to hold her hand, but I wish someone had stayed to hold mine. When we had first checked in they actually wanted to take her off all meds except phenergan and oxycodone around the clock, assuming what we wanted was sedation and the shortest time to getting it over with, but I was still hoping for a little quality time, and I did insist they keep other things going...we got a wheelchair ride to the garden and a couple of pizzas shared out of the deal. I had not been comfortable when my mom first asked for DNR but with her heart the way it was, severe, diffuse, and inoperable coronary arteries, it would have been cruel to keep trying to make that heart keep working and I had to accept that. We could have tried a procedure called EECP but I did not think she could tolerate it, and we could have kept anticoagulating which was not really working anyways (she came into hospice having had another stroke and/or coronary event where she had passed out at the skilled nursing facility, even on the highest dose of Ranexa and nitro she could tolerate) and I still wonder if we could have had a little more time that would have been worth anything if we had tried that. So, no, it is not easy to decide, but you do have every right to talk it through with the doctors and nurses and settle on what you think is right and best in the face of the inevitable. It should not be a cookie-cutter one-size fits-all type of thing.
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Shortmomma - My dad passed away in October of last year. I had pushed to have him admitted to hospice because he no longer wanted to go to the hospital but I didn't want him to suffer needlessly when the time came that his congestive heart failure worsened, as it does. The hospital would give him meds to get the extra fluid out of his lungs, readjust his meds at home and he'd be ok for a month or so then back through the same cycle. The experience we had with hospice was wonderful. The nurse, nurse's aide, social worker, pastor - all were nothing but supportive, assuring me that at any time I could send him to the hospital and if we decided to treat him for his heart failure, they would simply discharge him from hospice so that Medicare would cover the hospitalization. I never felt like they were giving up on dad or pushing assisted suicide. However, when the time came, and it came very suddenly in dad's case, it was comforting to know that they had the meds that could help him remain more comfortable and not struggle. As opposed to hospice expecting me to administer the meds that day, when the hospice nurse got to the house within a half hour of my call, because I too am a nurse, she said to me "Now YOU are the daughter and I am the nurse. Just be here for your dad and I'll take care of his comfort needs." I know she gave him much more Morphine than I would have been comfortable with and it didn't stop his breathing, it just helped him not struggle so hard. He was still talking to me and the family but wasn't panicky about his breathing even though it was clear he was not breathing normally. And as another has said, if you don't like one hospice, call another. I got lucky with the one dad's doctor recommended but had called several others to better understand the whole process. And instead of thinking you're hanging out just waiting for her to get sick, cherish this time. Spend as much time as you can with her, talk to her about how she feels about dying, tell her everything you want her to know and listen to all she says. Those will be the memories you will cherish forever. God bless ~ kuli
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Lildebb39 is right. The disease is what's killing them. Hospice will make them feel dignified and comfortable. There is no reason for her to suffer or have any anxiety over her breathing. They will keep her comfortable and ease any pain she may have. COPD is scary...try being a fish out of water. Can you imagine how scary it would be to breathe. Thats where they will come and assist her to a level of comfort. It's not suicide at all. They don't kill you..they comfort you. Its the disease thats killing her. I'm not familiar with COPD as much as dementia but I know when mom was in her last hours...she never had any pain or discomfort. She showed any wrinkles in her brow she was administered medication to help. The dying was inevitable...so why should it be so excruciating and scary. Hospice are angels on earth.
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From my understanding of it, the Do Not Resuscitate order is in place so that the patient (who is expected to pass away soon) does not need to have a breathing tube installed, which would only prolong this final period and can be very difficult for the patient. My mother asked for the DNR order, and she received her wish at the end of her life. She did not end up in the hospital on a breathing tube, being kept alive by this device. She was allowed to peacefully pass while in the ambulance.

Shortmomma, I don't blame you for not wanting to administer the morphine, or whatever the drug is they are talking about. Can one of the hospice nurses be responsible for administering the medication? I am sorry you are going through this....God bless...
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My experience with hospice was this - I interviewed 3 different hospices before I chose the one that my dad's doctor had first recommended. Yes, during the first meeting they talked about discontinuing all of dad's medications. However, when HIS nurse came we looked over his medications and she left the choice up to me what to continue and what to stop based on what meds would keep him comfortable. In my dad's case, with end stage congestive heart failure, we kept him on all of his heart meds, his diuretics, his rheumatoid arthritis med, his coumadin but stopped his oral diabetic med and some supplements because they weren't necessary. I was also told that anytime I wanted him to go to the hospital, I had the choice. If the hospital decided to admit my dad, I had to let hospice know so that they would discharge him from hospice. Once he returned home, we could then readmit him to hospice but could also decide not to. My goal in all of this was to not only keep dad comfortable but to reduce the number of hospital visits for him. He hated being in the hospital and was getting more and more confused each time he was there. It was so hard to see them tie him down and have someone watching every move he made just to keep him safe. Dad did go to the hospital a few times and the ER doctor would ask what measures were to be taken. One time, a week and a half after dad was admitted to hospice, they thought his diagnosis was a combination of pneumonia and CHF and I said give him 24 hours of IV antibiotics to see if he gets better and if not we would make decisions at that time. He got better and came back home the next day. Hospice did ordered oral Morphine for my dad and it was a life saver. My dad had suffered with severe back pain for years. He couldn't take over the counter stuff because of the coumadin and his options for pain pills was very limited. Even though he usually would only take a minimum dose 3 times a day of the morphine, he was so much more comfortable. I also could see that it did help his breathing. I always thought the opposite but it allowed him to relax and take deeper breaths instead of panting and getting more anxious. And when my dad was heading down the last road, they were there one hundred percent, helping with whatever they could. The day he died, I couldn't even think straight when I realized what was happening. I called his hospice nurse, she came right over and gave him morphine. He was able to relax a bit but was still conscious and able to talk to us. Without that, he would have suffered for much longer with feeling like he couldn't catch his breath. That would have been torture not only for him but for me. I always promised him I would do what I thought was best and he trusted me. There would have been nothing I could have done that day without hospice and the meds they provided. He was in hospice for almost 5 months and those were his best for the whole year. I'm sorry that anyone feels that hospice is assisted suicide. I had just the opposite experience. Kuli
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I know many people that say Hospice is the best gift they gave their family and loved one. As a Hospice volunteer, I always felt I was the one gifted by being able to share such a special time with my families.

I've had people say that their loved ones' condition was like a "big elephant" in the house until Hospice arrived. Families usually come together as a unit at this time and talk about things they should have shared years ago. Perhaps having us there helps them feel less burdened and they are able to open up to each other.

I am so sorry for your loss and I am glad you were able to spend time with your Mother. I am sure it meant a lot to both of you. God bless!
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My mom just passed away January 1st. The nursing home suspected pneumonia and ordered a chest x ray a little over a week before. THey were going to give her iv's and blood work. I refused because my poor mom (95) didn't want to be poked and prodded any more. She signed a DNR over 25 years ago, and I respected her wishes. I called in hospice right away. It was the best thing possible. They gave her medications without needles, and gave her 24 hr care. They were so supportive of me and my family. If it weren't for those people my mom would have never been able to go as peacefully as she did. They give the meds to control the congestion and relieve and stress and pain. My mom passed away very peacefully at 4:05 am New Years Day,
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Hospice is the best thing that ever happened for me and my sweet mama. She had Lewey Body Dementia and if they weren't here to support I would have given up on her along time ago. With hospice you have the support of many caregivers, CNAs bath aides, doctors, nurses and the comfort pack that takes care of all the needs for any comfort and care meds. All paid for by medicare. Hospice workers came to my home 2x times a week to bath or care for mom with any hygiene needs, the nurse came in 2x times a week in the end. They set us up with equipement and hospital bed, trays, bedside comode. Any supplies to help her with incontinence. It was a God send...not assistant suicide. If you have to do this all yourself you will see it's a pretty hard thing to endure. And they are there to help you with anything you need to care for her. It looks like your Mom is in final stages of COPD and she is having panic attacks, thats where they take over and help her with any medication that will keep her calm and make it easier to breath. They make sure that in the end your mom does not suffer. I know this because today at 1 am my sweet mom spent her last 5 days on this earth in the Hospice house. They kept her comfortable, without any distress. These people that work for Hospice are the nicest, most caring, loving and compassionate people. I feel so grateful to them for making moms process of dying easier and dignified. I hope you will see that and give them a chance. Because I will just say your going to be overwhelmed with the anxiety of seeing her suffer at any time. Good luck and God bless.
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I'll say just one more thing about hospice and then shut up. Before my experience with hospice with my dad, I used to think what a depressing job it must be. As a nurse, I am used to focusing on helping people get better. The problem is that these days people can be kept alive long after they are enjoying a quality life. After my experience with hospice, I have and still do consider working for a hospice in the future. I now think there is nothing greater in this world than to be able to help someone through the process of dying - not just death but the time before that as well. Most people know they're dying and must find it so comforting to have people they can express their fears, their thoughts, their unfinished business, their regrets with because I know in my dad's case he didn't want to upset any of us with that. He seemed so ready when the time came both physically, mentally and spiritually and I know it was in part because of the hospice staff he had in his last months. This was a journey I'm so very glad I was able to share with him and one I'll never forget. Dying at home with family all around is so very different from dying in a hospital. I know, I've seen both now. Best wishes ~ Kuli
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