END OF LIFE — Revisited

A recent NY Times article in the health section on 2/23/10 titled MURKY PATH IN DECIDING ON CARE AT THE END by Gina Kolata merely reinforces my belief that this topic needs to be addressed on a continual basis.  This is a painful, difficult and complex issue.  It is not clearly defined.  The paths of action are to be undertaken carefully, sensitively and on an individual basis.

The essence of the article involves two patients–one a two year old with severe developmental issues and the 90 year old demented grandmother of a physician.

In both cases when death seemed imminent, cardiopulmonary resuscitation was utilized.  In the case of the boy, despite his death and the poor quality of his life, his parents felt vindicated in insisting that "everything be done".  It is hard to argue against such an attitude, despite the boy's severe incapacity's.  Age is a factor which cannot be dismissed.  Even a young severely disabled child is still "too young" to die in the minds of his parents.

In the case of the 90year old demented grandmother, however, I disagree with the decision of the family to have CPR done.  Despite the emotional attachments we all feel towards our loved ones, in this situation, a long life has been lived.  The elderly woman suffered from dementia.  The success of her CPR meant she would stay "alive" in the physical sense only.  Her family of doctors felt it was a necessary act.

From my point of view, however, such a decision should be based on what is in the best interest of the patient, not the family.  I would have elected NOT to have CPR done on my mother under such circumstances because I know that she had no meaningful quality of life. 

Yes, to me that phrase does have meaning.  Living does not mean existing in a vegetative state.  Would I want my family to take of me, to see me in that state of being–absolutely not.

There is no quality of life.  A cognitive existence is over.  Death is certain and sometimes a form of healing for all concerned.

I know this attitude may seem inappropriate to some.  This is not euthanasia. It is also not hypocrisy.  I apply the same standards to others as I do to myself and my family.

It was the course of action my family adopted for my own Mother who died in her own bedroom, in her sleep, without the benefit of CPR.

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