Back in 2003, after my mother died, my father put his house on the market and moved to Colorado to live with my sister.
He was 83 years old.
And it was as that point that I put place in my nefarious, convoluted scheme to deny my father health care that would, perhaps, have kept him alive.
I took him to see a lawyer.
Despite his advanced age, my father had never drawn up a will, living or testamentary. He did not have a medical power of attorney, meaning that if anything happened to him where he was unable to communicate or became cognitively impaired there would be no "chain of command" to make medical decisions on his behalf.
The Dadster had a lot of physical problems: he had type 2 diabetes, high blood pressure and glaucoma and took a fistful of medications every day, as well as the application of twice-daily drops in his eyes. His mobility was limited and he had trouble maintaining his balance.
Along with his physical decline, he also was showing signs of cognitive impairment: he had had several episodes of stress-induced sleep walking; couldn't remember to take his medications; would re-tell the same anecdote to the same person several times within a couple of hours; confused names and places; and engaged in confabulation. His deficits at age 83 weren't severe, but they were present, and they were increasing. These impairments were due to vascular dementia: we knew that the Dadster had some blockage in his carotid artery, restricting blood-flow to his brain. But because of his age, and the low degree of blockage (about 50% at the time of his death), it was advised that he not have surgical removal of the blockage.
The Dadster was a simple man. Oh, I don't mean simple-minded; he was plenty intelligent. He'd worked as a master machinist for four decades and was a problem solver extraordinaire. But he wasn't financially sophisticated and never graduated from high school. He'd left all the finances to my mother (to his detriment). Dad also was a trusting soul, especially when it came to women. Dad loved riding the train around the country, bouncing between his children's households and chatting up and flirting with every pleasant woman he met. Indeed, within a few months of my mother's death, Dad had a girlfriend whom he'd met on the train.
So after we got Dad settled in Colorado, I talked with him about the importance of putting his legal affairs in order, and took him to visit the kindest, most gentle and understanding lawyer I knew who did this type of work. I felt Steve would be a good choice as he was dealing with his own parents' decline and had a good grasp of how to explain what Dad needed to consider in making these decisions and committing them to legal form.
By the time we left Steve's office, Dad had put into place a living trust to protect his monetary assets; a testamentary will; a living will, and a fistful of medical powers of attorneys. Because of Dad's penchant for travel Steve had to get creative. So, whichever household Dad was at, the blood relative at that household had power of attorney while Dad was in that state. Each of us received copies of all the paperwork.
And very importantly, Steve walked Dad through, item by item, what medical procedures he would want, and would want withheld, when the time came to have those decisions made. What came through most thoroughly was that Dad did not want to spend months declining in a hospital before dying. He even went so far as to direct that if he were in a coma nutrition and hydration, as well as mechanical ventilation, should be withheld. He did not want "kitchen sink", try-anything medical procedures to keep him breathing.
The coma scenario is what most people think about when they execute a living will. But, often, that's not where the most difficult decisions have to be made. Instead, it's in the case of an illness that can be treated in a hospital, but which cascades into other medical problems which also can be treated, but which will, at base, mean a person ends his or her life as a patient, and not as a person.
With the Dadster, it started with a fall in Spring, 2007. He was at my sister's house out in Washington state when he took a dive in the bathroom. Despite his protestations that he was all right, she called an ambulance and had him taken to the hospital. It was discovered he had pneumonia and was put on antibiotics and, for whatever reason, his dementia roared out of control, seemingly overnight. Instead of the sweet, gentle man he was in his normal state, he became an ill-tempered, foul-tempered, foul-mouthed, racial epithet-spewing, combative asshole. And he was hallucinating. When the hospital transferred him to a facility for the physical therapy which was to lead to his eventual release from medical facilities, he became so agitated and uncontrollable they called the police and had Dad taken to a mental facility and put on a three-day hold.
While he was on the psychiatric hold, Dad developed a bladder infection -- which was treated with antibiotics. Then came the second bout of pneumonia. It was at that point that Dad's physician asked if Dad had any formal medical directives. It was his medical opinion that Dad was not going to recover; instead, he'd go from opportunistic infection to opportunistic infection while his mental condition continued to decline. Not only would Dad never walk out of a hospital, he'd become even more mentally unstable.
Now, I come from a large family: I'm the youngest of six. And my four eldest siblings, especially, can fight amongst themselves over just about anything. Had Steve not walked the Dadster through all his options, including those outside the "you're in a coma do you want to pull the plug" scenario, we could have had a hell of a fight over the old man's last breaths.
Dad's doctor suggested that my sister bring in dad's living will, and they went through it with the hospital's medical ethicist, lawyer, and the doctor. It was agreed by all of them, looking at the totality of the document, that Dad, indeed, did not want to live and die that way.
Instead, although a couple of the siblings and grandkids had reservations and felt guilty about it, Dad was removed from the hospital and transferred to a hospice facility. There -- away from the machines and poking doctors and nurses and bustles of a hospital -- Dad regained his mental stability such that he could say his goodbyes before finally drifting down into death.
And this was accomplished without recriminations among the family members. It was Dad's decision -- and we had the paper to prove it.
So I admit it: I loved my father, and I killed the old man. I made it possible for "life giving" (but is it really life?) and expensive medical treatment to be withheld from him.
And I have absolutely no regrets.
Update [2009-7-31 16:5:4 by Frankenoid]: Thanks for sending this to the rec list. But I have to go now, first to pick up my son, then to head to the airport. Will check in when I find a wifi connection.