Wrenching Decision

My 99 year-old mother-in-law is at Mercy Care Center where, once a month they do an evaluation on each patient (this is not her picture). Sally always goes to these but at the last one there was a question that was new: after listing all her meds they asked "do you wish to continue prolonging her life or stop those drugs and just continue those that prevent pain?".

Sally years ago worked out a medical power of attorney with her mom when her mind was still clear and she was adamant that her life not be prolonged. If she suffered a medical crisis there was to be no life support, no efforts at resuscitation.

But there was no crisis and it was not clear what she should answer. But Sally focused on the phrase "prolonging her life" and chose to stop those medications. Her mom is now taking only drugs for her arthritis. The heart medications are gone.

Lita (Spanish diminutive for abuleita or grandmother) does not always recognize Sally now. Or her grandchildren. But on other visits she plays a lively game of cards and jokes with the staff.

She has had a proactive and exciting life . . . a degree from Stanford, a teaching career, two husbands, three successful children, and several years as a business owner in Mexico. A strong, independent, and at times even formidable woman.

So at nearly the century mark after such a full life she would be the first to agree. Yet when the doctor called to confirm Sally's decision she was shaken. He wasn't all that gentle about telling her that she must understand that letting nature take its course with this decision could lead to stroke or heart attack and death. Did she really want this?

But after talking with him for quite a while affirming her decision he confessed that it was exactly what he would do if it were his own mother. While Sally felt relieved at that she is still feeling the enormity of the decision which many people make for their parents and loved ones. "Pull the plug".

We talked for a long time; if she did suffer a stroke because her heart meds had been taken away would it cause her suffering since no efforts would be made to revive her? Is removing life-prolonging meds really following her wishes?

And a real head-scratcher; does a person in her condition KNOW what the quality of her life is at this point? And if she does not know is it our responsibility to decide for her whether to live or to die?