I am a devout Christian and minister who has/had the responsibility for the care of my aging parents. Both Mom and Dad have spent the past several years in a nursing home, when it became unsafe to keep them in the home any longer. My dad passed in December, and my mother is in her 11th year of Alzheimer's. For the past four years she has been non-verbal and non-responsive. All her food is pureed and fed to her.

After my dad's passing I found my Mom's Living will which states that she does not want nutrition and hydration to "artificially" extend her life.

I am looking for counsel and advice. I have absolute certainty about her eternal destination, as I did with my dad. I did not/ do not fear the death of my parents, and I am at peace. I am uncertain about the morality of removing food and hydration from my mother, even though I suspect that it would be her wish.

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Wow, so glad I found this forum. Thanks for all the kindness, encouragement, and counsel.

update: Mom is not refusing food, but is hand fed specially prepared food as her swallowing is impaired.

Your comments and my further searches haves helped me to determine that “artificial” likely means a “feeding tube.” Her advanced directive would refuse both a feeding tube and any IVs for hydration.

So long as she still accepts hand fed food, I will ensure she has the opportunity to eat. If she refuses at any meal that is her choice, and I will instruct the caregivers to honor her disposition, and not overly encourage, or force her to eat.

Thanks for you help.
Grace & Peace
Helpful Answer (32)
GraceLPC Jan 2019
I am glad you found peace and useful guidance. May the Holy Spirit continue to fill you with all you need in this difficult long goodbye.
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I struggled with this when my mother no longer had any appetite or motivation to feed herself, since she eas solely in my care it would have been simple to withhold food and hasten her end.
Instead I made the decision that as long as she opened her mouth when I offered food I would continue to feed her and I know in my heart it was the right choice, if she had ever actually refused to open up and eat l would have honoured that.
Helpful Answer (27)

I know where you Husband was 12 years with Alzheimer's and the last 5 or so was non verbal.
If your Mom is not on Hospice you should make a call I think they would help you a lot.
If the person is not eating or drinking to give them food or fluids can cause more harm than good. If she is still eating the pureed food and drinking thickened fluids then continue on. Once she stops eating, she closes her mouth and no longer responds to the cues to open her mouth then you know it is her wish not to eat. You can try a few more times but don't force it.
In the last stages of life the body does not process food or fluids, it does not need the food or fluids. Since the body is not processing any food given may just sit in the stomach or gut and begin to decompose causing pain.
As a person is "Actively Dying" the body is doing 2 things it is keeping the heart beating and the the lungs breathing. Even those 2 tasks are difficult and you may see or hear that the breathing stops, heart bet becomes irregular or very slow.
Since the body does not use the food the person will not show signs of hunger. Fluids can be used with a swab to keep the mouth moist but to give someone something to drink may cause fluids to enter the lungs creating a bigger problem.

At this point keep your loved one comfortable, hold their hand, tell them that you love them. tell them that you will be alright, the family will be alright and give them permission to go.
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I scanned the posts, so sorry if this has been said.

When we start the dying process, our bodies start to shut down. First thing is we can't swallow. We no longer feel thirst or hunger. If they try to feed you, the body can no longer absorb nutrients so feeding doesn't help. My daughter is an RN in a rehab/NH facility. She told me to never allow a feeding tube for my 89 year old Mom with Dementia. Better to allow nature to takes its course. If a tube is put in, its hard to get it removed. Because the medical field feels you now are starving the person.

If you don't have hospice, have them come in and evaluate Mom. They can tell you if her time is coming. Really, do you want to prolong her life. She left a long time ago. Her soul is just waiting to be released. Its hanging by a thread. Hospice does not withhold if the person still wants to eat and drink. They just won't force feeding. Mom will be kept comfortable and pain free. Two weeks before Mom passed she closed her eyes. Could respond to people talking and she was taken to the common area during the day. Then, she couldn't swallow. Then she wouldn't get out of bed. I chose Hospice to come in. My daughter checked Mom out and agreed. She passed six days later. Miss her, yes the person she was, not what she had become. My Mom knew she would go to heaven so I am at peace.
Helpful Answer (19)
cwillie Jan 2019
I was thinking this myself, but the wording of the question puzzled me- to me withholding means something different than not forcing nutrition at end of life
If she is not fed, does she seem to look for food? Does she indicate she is thirsty- ever? If my loved one seemed to want to eat, I would continue to feed her.

My sister died of a brain tumor. She became unable to communicate with us in any way. Towards the end of her life she just did not want to eat anymore, so we let her stop eating. Then it became difficult to swallow and although she did not seem uncomfortable, the family tried to continue to give her liquids. Eventually, we settled for swabbing her mouth and using eye drops. We just wanted her to be comfortable.

In nature, animals that are dying do not eat or drink. I don't think they are in distress. I think the body knows what it needs to do. Have you consulted a palliative care group? They could probably help you with your decisions.
Helpful Answer (17)

I cared for my mom in my home. She didn't talk for about a year before she passed. We fed her soft foods by hand and offered drinks, water, coffee(mixed with ensure) and ensure. We had decided early on no feeding tube, but I could not just not offer her food. Personal choice. She ate less and less. Then swallowing started being a challenge. Finally she just couldn't eat or drink. She went 8 days without food or water and finally took her last breath in April. I stayed with her those final days and was lucky to be holding her hand when she passed... Something I promised her. It was very peaceful. I also knew and know where she would be going. I know the Lord welcomed her with opening arms. I did not want any regrets or guilt so whether it was morally the right thing, I can't say, but at least I know I did what I could and helped her as she left this world. I think we each can only do what we feel is best for our loved one. As long as that is what is in your heart as you make the decisions, then it is morally right.
Helpful Answer (17)

I'm sorry you're in this dilemma, Tnekver62. After being my mom's live-in caregiver till she died in April, I changed my advance directive (living will) to specifically state if I'm in final stages of Alzheimers and dementia to stop all artificial means of keeping me alive, including nutrition and hydration. I mean it! I would hope someone would implement it.

I'd show the living will to and speak with your mother's nursing home DON (Director of Nursing) and her doctor if she's to the point she mentioned in her directive. They can give you advice. Although you're a minister yourself, you need to talk with another minister or counselor to help guide and support you too.

Even though it's her wish and I know it would be a kindness to let her go, I can't imagine the impact on you. I can't imagine how traumatic it would be to actually implement it. It would be hard, but I'd do it.

As for morality, what's better FOR HER: implement her instructions and let her go or make her continue this way, possibly for years? Best wishes to you.
Helpful Answer (15)

It may not be the legal definition of “artificial” feeding, but to me it has meant a feeding tube, not hand feeding. You mentioned “removing” food and hydration, not that she is refusing it. Am I understanding that you’re contemplating actually withholding (removing) food? If and when my Mom gets to the point of these decisions, I could not decide to “withhold” it, but would offer it until she refused. So when she eventually refuses consistently, it will be her decision, not mine. So refusing vs removing/withholding are 2 different scenarios in my mind. Have you clarifed in your mind the differences, if any to you, and what “artificial” means to you and your Mom?

Thank you you for bringing up this hard topic, as it helped me think through my own plan.
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Is mom on hospice care? I would assume so. If yes, you will find support there, they will have a chaplin. If not, get mom evaluated today, she will receive great comfort and support as you and family will.
Helpful Answer (11)

Could you clarify what you mean by unresponsive, please?

When people refer to "artificial" feeding, they are usually talking about PEG feeding or tube feeding, which issues tend to arise when the swallowing reflex is impaired. They are not talking about a demented person being assisted to eat puréed food.

I can imagine how emotionally draining it must be to witness your mother's state for four years; and you now have the loss of your father to mourn too. Has anything else changed in your mother's condition?
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