Do You Have A Right To Die?

Burbank, California 91504

by Karl Loren

I’ve been wanting to write this Viewpoint for a long time!

Do you, or does anyone, have a right to die? Can anyone interfere with that right? Do you have a duty to die? When does your time to die come? Whatever does that word time mean, there?

For some time now I’ve been living through an experience with my mother-in-law. There is so little chance that she would ever read this that I’m going to bluntly describe the exact facts of the situation, even though I won’t mention full names.

The names in this story are Bonnie, my wife, Mom (Dorothy) my mother-in-law, and Bill (who became a companion to Mom).

Mom has been a fine mother-in-law in my married life – for more than 20 years. My wife’s brother, too, and his kids, were fine family members – even though we would probably never see eye-to-eye on many matters, particularly including health care, diet and vitamins!

So, my wife, Bonnie, and I would go visit Mom, Dorothy, regularly. And she would occasionally come visit us.

After the death of her second husband, she found a great friendship in a 40-year family friend who, likewise, was then without a companion.

At first, as they "dated" – she was, you know, 83 years old -- they worried about how the kids would view this new relationship. We all encouraged them to live together and offer as much love to one another as they might wish. We children, and even the grandchildren, could see no fault for Dorothy seeking a loving relationship at her age. She had, after all, great grandchildren she could still love and enjoy!

She had moved in with her new/old friend, Bill. Mom sold her home, and most of her furniture. She had expected to live the rest of her life with her new "companion." She had also mentioned, several times, that she wanted to die before he did. She could not face the possibility that she might survive THREE men.

And he, that old family friend who had taken this new role in her life, was so obviously good for her that all the rest of the family applauded her moving in with him. They traveled together in his motor home, and even made plans for cruises and other trips.

So, Mom led a reasonably busy life – traveling around the country, spending her built-up estate carefully so that it would certainly last her through many more years of comfortable living in this new relationship. He too, you see, was not affluent, but very comfortable with his pension and estate.

By no means were either of these two senior citizens anywhere close to the poverty line!

As a family we had not been without discussion of the matter of death or disability.

Mom expressed, often and pointedly, that she did not want to "linger." She had, as a young mother, her own mother who spent more than 20 years rotating among the eleven of her living children, living with first one, then another, for a month or so. Grandmother Snow, as her children and grandchildren referred to her, was very helpful during those visits – working in the kitchen and with cleaning. Up to the day she died, at 93, she was still contributing more to the life of any home than she took from it.

In any event, Mom didn’t ever want to become a charge on HER kids. She had, in the manner of many later generations of her Mormon heritage, only two kids, not twelve as had her mother. And, her two kids were busy and active in ways that she and her brothers and sisters had not been when Grandmother Snow came to live for a while.

So, as Mom got older, still in excellent health, she would often say to Bonnie, my wife:

When I die I want it to be fast. I don’t want to linger. Promise me you will never allow them to keep me alive by sticking tubes down my nose and throat! Don’t allow them to use "heroic" efforts to keep me alive.

She even put some of this into writing – in her "living will" and her "power of attorney" where she made it clear that whoever was to start making health-related decisions for her, if that became necessary, was not to allow any extraordinary medical procedures to maintain her life if, without those procedures, she could not live.

It was actually much more carefully and scientifically stated, since the State of California, like many states, gets doctors and hospitals off the liability hook by providing pre-proven legal documents for model power of attorney forms. Mom signed one of those and both her kids were not only witnesses but were in full agreement.

That, as you’ll see, was an intellectual agreement during the analytical time of thinking about the matter – not a time of stress when a dying, or even just-dead, mother might, or might not, be a candidate for some dramatic life revitalizing medical procedure.

So, life continued, with no cloud on any horizon. We knew she wouldn’t live forever, but it seems that older people don’t get worse gradually. They do giant and unexpected jumps downward!

They are doing fine one day, and the next there is an "event!" It might be a stroke, or a "discovered lump" or a fall. Whatever it may be, it is usually sudden and unexpected.

So, Mom had one of those events!

It happened, sadly enough, in March, 1995.

Mom was feeling dizzy. She actually fell when she got out of bed to go to the bathroom one night. She didn’t hurt anything – just a small bruise. But, she stumbled in the semi-dark, fell against the bed, and the next day she realized that she just wasn’t as steady on her feet as she used to be.

The next event in this series was in September, 1995, also not very dramatic. Mom awoke one morning, while she was living with Bill, and she started wandering around the house – disoriented.

Bill found her wandering in the house, not knowing where she was.

It was a terrible shock to Bill, particularly because of Bill’s personal situation with regard to his wife.

Bill decided that Mom should go to the Emergency Room of the local hospital. Notice how someone has taken over making health care decisions for Mom – someone who Mom loved and trusted, but nonetheless, how son and daughter were moved out of the loop.

Hospitals will generally always do the exact procedure which provides the greatest amount of income. The costs in an emergency room, of course, are enormous, and patients are charged full-rate when the insurance will cover it.

Mom’s insurance was one of the best!

But, after a couple thousand dollars of emergency room care the hospital then decided that Mom needed a stay in the hospital – to handle what they called had been a mini-stroke and some unknown problem that needed lots of tests.

They said that there was no damage to the heart, but that there had been a mini-stroke and that she would need time and care to recuperate!

Finally, the doctor told us that Mom needed a gall-bladder operation – that her gall-bladder was not working properly, and was putting toxins into her body.

Now, at 83 it’s a very serious event to have such major surgery. Bonnie and I were strongly opposed to such surgery, feeling that there would be many more natural alternatives to this problem – and having a long-standing suspicion of the opinions of doctors.

Nonetheless, with Bill’s urging for standard care, Mom had the surgery.

After some period in recovery, Mom was ready to go "home." Now, the question began to surface – where was her home?

She had sold her home, moved in with a man she loved, and he was starting to have second thoughts about his promise to care for her.

And why not. If you’ve read the Endnote about Bill, you’ll realize what a terrible strain HE was under about this.

She did go back to his home, but it was increasingly clear that she was no longer able to take care of herself.

She was often disoriented and confused. Bill found that he could not leave her to herself, for fear that she would come to some harm. He had to help her with her bathing.

There was no event for the next change in her living situation.

After several months of trying to handle the situation, Bill let us all know that it wasn’t going to work. He couldn’t continue to care for Mom. Bill’s kids, too, felt far more concern about him than Mom, and urged him to get out from under the responsibility.

So, there we were with a Mom who could no longer fully take care of herself. She certainly didn’t need any full-time nurse, nor a hospital setting, but neither was she ever again to run a home, cook for herself, do any cleaning, or care for herself in any meaningful way.

So, the painful decision was made that Mom should move in with Brother!

Remember that Mom had already made a powerful decision to die – when her second husband died, Mom didn’t want to live.

Bill had come around as a new possibility of a happy life, but her second postulate, also powerful, was that she should never again suffer the pain of losing a loved one – that she should die before anyone else close to her.

You see, there is something worse than death – that is living in an old, damaged body when you truly don’t want to be there.

relationship!

He had his own family, his own life, his own future, even at his 78 years of age! He had a family of kids and grandkids, and his health was excellent.

With one event of dizziness Mom had lost, forever (?) her future of traveling with the man she now loved. What was left to her other than the original decision to die? Believe me, when the spirit decides to die, only the spirit (not a doctor) can reverse that process. A doctor can force the spirit to stick around, in a terribly ill body, but life and health must start with a spiritual decision.

Mom had made that decision, and the removal of Bill from her life returned her to that decision, with ferocity. It was just as if she had now lost the third man in her life – exactly what she had vowed would never happen!

Those can be, as you will understand, very trying times.

Despite Mom’s very strongly held conviction that she never wanted to become a burden on her kids, it was obvious that she had now become the charge of one of her children.

While Mom’s money would pay for a few years of that private nursing home, the family couldn’t confront that arrangement.

How could you ever, for the Sake Of God, send your own Mother into a HOME!

Your situation could be a bit different, the same, or very different, but the components of YOUR situation would probably include each of the elements I’ve so-far described.

So, she moved into one of the empty-nest bedrooms of Bonnie’s brother. He was retired anyway, while his wife was still working. He had been staying at home, being a house-husband, and enjoying his retirement. She had, but hated, a wheelchair. She had, but refused to use, a walker.

Bonnie, a bit younger than her brother, and much more active in business, couldn’t take over a full-time caregiver’s role for her mother.

So, the very unpleasant decision was faced and handled. Brother became mother to his mother.

Mom moved into one of the empty down-stairs bedrooms in her son’s home.

Mom could still walk, go to the bathroom by herself, and generally participate in the family life. She certainly didn’t need to be bathed or fed by someone else. Then!

But, you know how those "events" occur! That physical and mental condition often changes in big jumps, and we had another of those jumps coming!

She had been living with her son for only two weeks. Bonnie traveled the 50 miles, one way, down to see twice during those weeks, and spent several hours. It was a terribly emotional time for all concerned.

Mom, during these two visits, had discussions with Bonnie about death. She was in full recall of her earlier decisions and desires as regards being a burden on her family She was not at all happy with the present arrangement. She told Bonnie she just wanted to die! She could not envisage herself getting "better."

Mother’s Day. Bonnie had gone to visit her mother on the Saturday before Mother’s Day, 1996. Then, the next day, Sunday, Mother’s Day, Bonnie and I went to breakfast with some of our own children.

By this date Mom had actually been living with her son for only two weeks!

We got home to the terrible news that Mom had had a heart attack that morning, and had been taken to the Emergency Room of her local hospital. That was all we knew at first. We didn’t know, on the first call, of the strange events inside the ambulance!

Bonnie and I went to the hospital immediately, and spent those anxious hours waiting for the news.

The verdict was that she had had a full-fledged heart attack.

Then we got the REAL news.

Actually, she had started to feel hot, and had some pain in her chest; Brother was worried enough to call for an ambulance. It happened that Bill was visiting at just that time.

They got her into the ambulance and Bill rode with her while Brother took his car to follow to the hospital.

Now, Bill knew full well, and had no disagreement, that Mom wanted no heroic efforts to save her life.

But, she had a massive heart attack IN THE AMBULANCE. Could the sirens have contributed to that?

The ambulance paramedics are very well trained for such events; they all carry those infamous electric paddles used to shock someone back to life when their heart has stopped!

Only two weeks after she had "lost" her new love, she was finally able to implement her decision to die.

I don’t have any doubt about your spiritual ability to cause your own body to live or die. Spiritual decisions are very powerful.

The paramedic instantly, and automatically, started to get the paddles ready.

Now, Bill was very emotional at this point. After all, the woman he had grown to love had died in his arms, and the paramedic was about to bring her back to life.

Bill knew, full well, that Mom didn’t want heroic treatment, but what would YOU do in this situation?

Here is one of the center points of this entire Viewpoint – how can you take the decision made in a time of rational thought, and be sure it is implemented at a time of emotional distress.

It’s one thing to wonder how you, yourself, might react if you were conscious and faced with the decision on allowing administration of heroic care to yourself. But, try to cast yourself in the role of a husband, loving friend, or a family member, who knows the dead one’s wishes, but also knows that this little procedure might return his loved one to life!

How would you behave in those circumstances?

Bill made no effort to stop the paramedics. They applied those electric shock paddles and brought Mom back to life!

In their Book Of History, I’m sure, they are proud of the number of life-saving procedures they administer.

Little do they realize the terrible damage this procedure does to LIFE!

Yes, Mom now was again alive! But, so is a vegetable alive!

Mom was in terrible condition. She had some sort of a small event, at her son’s home, and then a massive event in the ambulance.

Then, in the emergency room of the hospital there were more heroic efforts to salvage this frail 83 year old body in the name of a society that values living vegetables more highly then death in dignity! She was unconscious for two days. She actually stayed in the intensive care ward at the hospital for two weeks before she could be moved to the regular ward. She actually spent only three days there before the doctors were ready to ship her off to a convalescent hospital.

This was, incidentally, an 83 year old body that had smoked much of her life, had refused to take vitamins even though we offered them freely, and never ever questioned the wisdom of the doctors who had treated her with drugs over many years.

She had, for instance, watched her second husband die when we told her that the cancer treatment she thought was best for him was, actually, the cause of his death, rather than the cancer.

She, like much of America, had placed her faith in the modern medical model which says that drugs and doctors know best, and children, vitamins and alternative methods are to be graciously ignored!

We were there in minutes, of course, and spent more anxious hours at the hospital. Finally, she was conscious and we could see her – it was a few days later. During that time it was always clear that she would "live," but it was never clear at all what quality that "life" would have.

At the hospital, in intensive care, we didn’t know whether or not she would ever regain ANY ability to talk or walk. Gradually she "came around," and we figured that her almost total loss of memory was a temporary phenomenon.

She knew who Bonnie was, and me too, but after a minute of being with Bonnie, she would repeat some question which had just been asked, and answered, a minute before. It was not at all clear that she could ever have any semblance of normal living!

At first we didn’t know how long she would be in the hospital, and we hadn’t even considered what would happen if they wanted to put her in a lesser-care facility. How much would it cost? Would insurance cover? Could she ever go back to live with her son?

Fortunately, we didn’t have to get answers to all those questions immediately. The hospital had it all planned for maximum efficient utilization of the insurance dollar.

The hospital gave her very intensive "therapy" and insisted that she must be able to walk, and sit on a toilet without help. Then, they said, she could be discharged to the next level of care – the convalescent hospital.

She went from the hospital to a convalescent hospital where, we were firmly told, the insurance would pay for only 100 days. The full expectation was that she would leave that facility shortly and live with family! She stayed at this new hospital for two weeks while they trained her to dress herself and take care of some simple body needs.

That’s the law now-a-days! You get insurance for the catastrophic treatment. They turn you into a mobile invalid, and give you the choice of a private "home" at about $3,000 to $5,000 per month, or living with some relative.

I read a very well-written opinion column in my local newspaper recently, about this situation. The writer presented a story like that above, but concluded that the "solution" had to be an improved medical insurance coverage that would allow the disabled person to get unlimited home care, or convalescent hospital care, with full insurance coverage. The home care would be fully paid for visiting nurses, and the convalescent hospital care would be for the rest of a person’s life, not just 100 days!

So, we visited her in the hospital just about every day. It was a 100 mile round-trip drive for Bonnie, but during those first few days there was no possibility that she wouldn’t go every day.

I went a couple days, then begged off!

So, as we were all looking at the possibility of 100 days at this facility, it also became clear that the hospital was well-governed by the insurance provider, and they were NOT allowed to keep her for those 100 days unless it could be proven that she couldn’t go home.

Their job was to get her UP to a condition where she was no longer eligible for the convalescent hospital, because the criteria had been set so that when a living vegetable could also walk and take care of her own potty needs, it was time to leave.

In other words, the convalescent hospital was only, at least with this insurance, a place where someone must require more care than Mom required.

We were dizzied by the speed with which we found that in a week or two, she would be on the doorstep of that hospital – ready for the next place. The next place could be a return to Brother’s home, or a brand new experience in a private nursing home.

We were certainly not at all prepared to change Mom’s life that much – to take her to a private home!

So, back to her son’s home she was destined to go.

But, now she was a very different person.

First, she was often confused. She would talk sensibly for a minute, and then switch to an unrelated subject, and then ask some question showing that her memory of ten minutes earlier was gone!

Brother was now faced with the need of helping his own mother take off her panties so she could sit on the toilet.

Yes, being capable of using the toilet did NOT require that she be able to undress herself!

And, Brother was now faced with having to give his own mother a shower!

Bonnie and Brother decided to get a part-time visiting nurse. (Euphemistically, they are called custodial nurses!)

The nurse was a great gal! She had experience in these situations and took over all the responsibilities during the few hours per week that she was there.

Now, you can see that the situation has developed very naturally into a basically intolerable arrangement.

That was the situation at the time when Brother reminded Bonnie that he had a long-standing two-week family vacation planned, and prepaid. So it was that Mom came to live with Bonnie and me for two weeks.

I have certainly learned quite a bit from this experience – among other things it gave me the impetus to finish writing this Viewpoint – on a subject I’ve been wanting to address for a long time.

While Mom was here she did very well, within the parameters of wellness that would ever be possible for her to achieve.

She cried a lot, and laughed a lot, but mostly she soaked up all the time, attention and care that Bonnie could provide.

We had a visiting custodial nurse (I still can’t get used to that term!!) come in EVERY day, even if for only for four hours.

So, Mom had two very nice weeks with us – sitting with our dogs, enjoying the view, having an attentive nurse, and a caring daughter.

She cried when it came time to go back with her son. We softened that change by arranging that Brother would bring her to our home regularly to stay for a night or so, and then back to his home.

Oh, I didn’t tell you, while Mom was in the hospital after the ambulance event, one of her brothers, at 78, suffered a massive heart attack and wound up with partial paralysis. He seemed quite mentally alert, and could walk and move all but one paralyzed arm. But, he couldn’t move his throat muscles. He couldn’t swallow. So, he had tubes down his throat to feed him. HE was in a hospital setting – no simple nursing home would do for him.

While Mom was staying with her son, Bonnie and Brother discussed whether they should tell Mom about her brother, and decided against it. It’s amazing how many decisions you are faced with – decisions you’ve never anticipated. Should you, or should you not, tell Mom about her brother?

But, by the time Mom got to be living with us, Bonnie began to see some things very differently.

For instance, Bonnie decided that it was not morally right for her to prevent Mom from knowing about her own brother. Bonnie told Mom, and then arranged for a visit between the two of them.

That was, as you would expect, a very emotional meeting.

They certainly both were sufficiently aware to know who they were meeting, and to know the condition of each of them. Mom, sitting in her wheelchair (she hated having to use it), talking with her baby brother, now 72, and both of them crying a lot. Her brother, of course, couldn’t talk, but they could hold hands and Mom could talk.

Mom talked about it for days afterwards. It’s an interesting observation that Mom usually couldn’t remember something that had happened the day before, but she had no trouble remembering her visit with her brother, and she also had some future interest now.

She definitely wanted to go back to visit more with her brother. Coming, as she did, from a family of 12 children, only five of whom are now alive, you can guess that Mom had some important cycles to finish up with a brother who she normally only visited a couple times per year. As I recount below, one of the most important things an older person wants to do is to finish up any undone things from a whole lifetime.

While you may have an absolute right to die, you will find that it is very difficult to die when you feel that you have unresolved conflicts, or promises you’ve given and haven’t met. A person wants to leave this life feeling that they have ended the things they started.

Mom’s visit with her baby brother was an important part of her letting go of the responsibilities of this life.

So, Bonnie discovered that it was a very good decision to be very open and frank with her Mom.

Once, Mom said: "I must be a pain in the butt to you!" Bonnie, without hesitation, said "Yes!", because that was the truth. Mom tended to demand all of Bonnie’s time, but Bonnie often told her that Mom would have to sit by herself for a while, ‘cause Bonnie had some of her own life to lead.

What we’ve found is that Mom could accept the truth of situations far better than we had expected.

As you’ll see below, Bonnie was very upset with Bill for allowing Mom to be brought back to life when Mom had specifically asked that such heroic efforts NOT be used. We were all the more convinced of the mistake that had been made when we discovered that the electric paddles had acted almost as destructively as that most evil treatment of psychiatry – electro-convulsive therapy – ECT.

Some day I’ll write about this evil, and its origin. But, enough to be said here that when massive electricity is applied to the body, the body may, somehow, recover to breathing, but the mind is always badly affected.

Doctors may claim that it was the heart attack itself, that caused Mom to become so incoherent. But, I know that the massive application of electricity to her body shocked her into a past time of her life; she was caught up and stuck in that moment of the past.

It was a confused existence for her.

She actually changed from time to time, as to what part of her life she was re-experiencing. But, she’d go from an instant when she was 23 years old to an event when she was 53, and then since nothing in her immediate environment matched the reality of those past incidents, she would get confused.

I could write more about this, but it really doesn’t make any sense to try to make sense out of nonsense!

Mom was probably not at the level of response that would get her graded as mentally incompetent, or senile, but if you’ve ever been around someone like this, you know, too, that they are not completely in charge of their own mental faculties!

Mom would sometimes forget where the bathroom was.

So, Mom had been revived from the dead, against her wishes, to start a new life in the midst of a confusion of past memories, each of which seemed as real as the chair she sat upon.

Of course a conversation with her was upsetting!

Well, that’s the end of the story for now. She’s back with Brother, and will be visiting our home regularly. Brother, using Mom’s money, has taken our suggestion to hire a full-time live-in custodial nurse at less cost than the nursing home.

Bill never came around while Mom was living with us. He does visit her at her son’s home, but Mom cries for several hours after he leaves. No wonder! She loses her third man over and over again.

But, one of these days another event will occur, and Mom will either leave this painful existence, or drop down a notch or two on the scale of living vegetables.

Now, don’t get me wrong, about living vegetables.

Even now I have absolutely no doubt that Mom could return to a very good state of health.

As much as I’ve written and lectured about intravenous chelation therapy, and oral chelation vitamins, Mom would never consider getting such treatments.

Oh, she might have been willing if Bill had suggested it, but her daughter’s opinion on such a matter was certainly not to be regarded as valid along with the opposing opinions of the white-coated murderers in the hospitals she visited.

Bill was polite about our suggestions that he encourage Mom to go for I/V Chelation therapy. But, he didn’t "believe in it." She would have listened to him, but he would not speak that truth!

So, we know she could have been helped, and could still be helped.

You must want help. Help is not something that can be effectively forced upon you – despite what doctors and hospitals believe and practice!

Here is another of the central points of this Viewpoint: When someone has decided to die, they will succeed!

It was very painful for Mom to lose her first husband to cancer. He lingered on, causing Hell to the family while he died slowly and terribly.

She then remarried, several years later, and had a happy 20 years, but then watched her second husband die of cancer – while refusing to listen to our strong urgings that he refuse the terrible chemo-therapy and radiation which, we are sure, actually killed him.

So, as Mom had said many times to Bonnie, she didn’t want to outlive any other man she might take up with. She wanted to go quickly when her time was up, and she didn’t want to burden her children with her care.

Those were strong and sane decisions, reached when she was quite rationale. Undoubtedly you know someone who has made such decisions. Perhaps YOU have made such decisions!

Now that the electric paddles have lowered her sensibilities, she can’t even remember those decisions, but somewhere deep within her, those decisions still govern her life.

For instance, the doctors had told her there were these certain drugs she had to take every day, and that she couldn’t have ANY salt in her food, and that she had to drink one of the Ensure drinks with every meal.

While Mom was with Brother, he insisted she take her pills, avoid all salt and drink that Ensure!

While Mom was with us, Bonnie told her that she was in charge of her own destiny. If she wanted to throw the pills away, that was her right.

We believe that any person has a right to die. I’m not speaking about "assisted suicide," mind you, but I am talking about a person making his or her own, personal, decision to die. While it may still be a questionable practice, Dr. Jack Kevorkian’s services have recently ruled to be legal, despite many lower level courts and medical groups to put him in jail. Two different Federal Appeals Courts have decided that a person, when in competent mental condition, has a constitutional right to choose to die, and that he who gives assistance in decision is not acting illegally.

The MUCH larger question has to do with forcing people to live when they do not want to! That, I consider, is certainly unethical.

Would YOU force your invalided mother to swallow pills just because a doctor said she should!

Mom would tell us that she didn’t want to take those damn pills, that she wanted some salt on her food, and that she disliked that chocolate drink.

We gave her the freedom to make these decisions for herself.

Her deeper self, her earlier self, indeed even her body, was running on the postulate of death being better than living in this condition.

Faced with continued existence in this living vegetable condition, she was looking for every possible way to achieve her goal of death with dignity.

Dying is not an easy action for someone to implement when he or she has been blasted out of mental clarity by electricity!

The electric shock and invasive medical care had virtually deprived her of the ability to carry out her own wishes, and she had been relegated to a condition where others were using THEIR purposes, rather than hers, to guide her destiny.

Brother has now changed, due in no small part of seeing how much happier Mom was while visiting us, and seeing that forcing her to take drugs was the ultimate type of insult to a mother who had cared for her kids for dozens of years!

We had made it clear to Mom that she was free to "go" whenever she wished to "let go." Many of the other people she cared for told her that "You have to live!"

You think I’m harsh and cruel toward a parent?

Nursing homes, particularly hospices (a hospital-like facility devoted to allowing patients to die with dignity), are faced with these situations constantly. One of them, in Florida, published the following in its newsletter for patients and relatives.

Keep in mind that the following was written for those with loved ones already in a hospice – a place where a person goes for the purpose of dying.

Mom might have decided that she wanted to die, but she was also not ready and afraid. No one around her would have agreed that she belonged in a hospice.

So, many of the suggestions below will seem quite reasonable for a hospice setting, but perhaps premature and not suitable for your own mother in a nursing home.

I suggest that these concepts are often even more valid outside the hospice setting – for when that sick person has made a sane and rational decision that living as an invalid is NOT better than death.

When a person enters the final stage of the dying process, two different dynamics are at work which are closely interdependent.

On the physical plane the body begins the final process of shutting down, which will end when all the physical systems cease to function. Usually this is an orderly and undramatic progressive series in physical changes which are not medical emergencies requiring invasive interventions.

These physical changes are a normal, natural way in which the body prepares itself to stop, and the most appropriate kinds of responses are comfort enhancing measure.

The other dynamic of the dying process is at work on the emotion-spiritual-mental plane, and is a different kind of process.

The "spirit" of the dying person begins the final process of release from the body, it’s immediate environment, and its attachments. This release also tends to follow it’s own priorities, which may include the resolution of whatever is unfinished of a practical nature and reception of permission to "let go" from family members.

These "events" are the normal natural way in which the spirit prepares to move from this existence into the next dimension of life. The most appropriate kinds of responses to the emotional-spiritual-mental changes are those which support and encourage this release and transition.

When a person’s body is ready and wanting to stop, but the person is still unresolved or unreconciled over some important issue or with some significant relationship, he/she may tend to linger, even though uncomfortable or debilitated, in order to finish whatever needs finishing.

Certainly some of Mom’s grandchildren were very upset with the idea of Mom leaving. They helped to keep her here. It appears, now, that Bill, too, was anxious about this. When the person you most love wants you to stay, you will probably keep that body alive no matter what pain has to be endured.

The experience we call death occurs when the body completes its natural process of shutting down, and when the "spirit" completes its natural process of reconciling and finishing.

These two processes need to happen in a way appropriate and unique to the values, beliefs, and life-style of the dying person.

Therefore, as you seek to prepare yourself as this event approaches, the member of your hospice care team want you to know what to expect and how to respond in ways that will help your loved one accomplish this transition with support, understanding and ease. This is the great gift of love you have to offer your loved one as this moment approaches.

The physical and emotional-spiritual-mental signs and symptoms of impending death which follow are offered to you to help you understand that natural kinds of things which may happen and how you can respond appropriately. Not all these signs and symptoms will occur with every person, nor will they occur in this particular sequence.

Each person is unique and needs to do things in his/her own way. This is not the time to try to change your loved one, but the time to give full acceptance, support and comfort.

The following signs and symptoms described are indicative of how the body prepares itself for the final stage of life.

1. COOLNESS: The person’s hands, arms, feet and then legs may become increasingly cool to the touch, and at the same time the color of the skin may change.

The underside of the body may become darker and the skin may become mottled. This is a normal indication that the circulation of blood is decreasing to the body’s extremities and being reserved for the most vital organs. Keep the person warm with a sheet or light blanket, but do not use an electric blanket.

2. SLEEPING: the person may spend an increasing amount of time sleeping, and appear to be uncommunicative or unresponsive and at times be difficult to arouse.

This normal change is due in part to changes in the metabolism of the body. Sit with your loved one, hold his/her hand, do not shake or speak loudly, but speak softly and naturally. Plan to spend time with him/her during those times when he/she seems most alert/awake.

Do not talk about the person in the person’s presence, speak to him or her directly as you normally would, even though there may be no response. Never assume the person cannot hear as hearing is the last of the senses to be lost.

3. DISORIENTATION: The person may seem to be confused about the time, place and identity of people surrounding him/her, including close and familiar people. This is also due in part to the metabolism changes.

Identify yourself by name before you speak rather than to ask the person to guess who you are. Speak softly, clearly and truthfully when you need to communicate something important for the patient’s comfort, such as "it is time to take your medication," and explain the reason for the communication, such as "so you won’t begin to hurt."

4. INCONTINENCE: the person may lose control of urine and/or bowl matter as the muscles in that area begin to relax. Discuss with your hospice nurse what can be done to protect the bed and keep your loved one clean and comfortable.

5. CONGESTION: the person may have gurgling sounds coming from his/her chest as though marbles were rolling around inside. These sounds may become very loud. This normal change is due to the decrease of fluid intake and an inability to cough up normal secretions.

Suctioning usually only increases the secretions and causes sharp discomfort. Gently turn the person’s head to the side and allow gravity to drain the secretions. You may also gently wipe the mouth with a moist cloth. The sound of the congestion does not indicate the onset of severe or new pain.

6. RESTLESSNESS: The person may make restless and repetitive motions such as pulling at bed linen or clothing. This often happens and is due in part to the decrease in oxygen circulation to the brain and to metabolism changes.

Do not interfere with or try to restrain such motions. To have a calming effect, speak in a quiet, natural way, lightly massage the forehead, read to the person, or play some soothing music.

7. FLUID AND FOOD DECREASE: The person may have a decrease in appetite and thirst, wanting little or not food or fluid. The body will naturally begin to conserve energy which is expended on these tasks. Do not try to force food or drink into the person or try to use guilt to manipulate them into eating or drinking something. To do this only makes the person much more uncomfortable.

Small chips of ice, frozen Gatorade or juice may be refreshing in the mouth. If the person is able to swallow, fluids may be given in small amounts (ask the hospice nurse for guidance). Sponge moisture may help keep the mouth and lips moist and comfortable. A cool, moist washcloth on the forehead may also increase physical comfort. Vaseline applied to lips, teeth or gums may prevent sticking, cracking or irritation.

8. URINE DECREASE: The person’s urine output normally decreases and may become "tea" colored, referred to as concentrated urine. This is due to the decreased fluid intake as well as decrease in circulation through the kidneys. Consult with your hospice nurse to determine whether there may be a need to insert or irrigate a catheter.

9. BREATHING PATTERN CHANGE: The person’s regular breathing pattern may change with the onset of a different breathing pace. A particular pattern consists of breathing irregularly, i.e., shallow breaths with periods of no breathing of 5 to 30 seconds and up to a full minute.

This is called "Cheyne-Stokes" breathing. The person may also experience periods of rapid shallow pant-like breathing. These patterns are very common and indicate decrease in circulation in the internal organs. Elevating the head, and/or turning the person on his/her side may bring comfort. Hold his/her hand. Speak gently.

1. WITHDRAWAL: The person may seem unresponsive, withdrawn, or in a comatose-like state. This indicates preparation for release, a detaching from surroundings and relationships, and a beginning of "letting go."

Since hearing remains all the way to the end, speak to your loved one in your normal tone of voice, identifying yourself by name when you speak. Hold his/her hand, and say whatever you need to say that will help the person "let go."

2. VISION-LIKE EXPERIENCXES: The person may speak or claim to have spoken to persons who have already died, or to see or have seen places not presently accessible or visible to you.

This does not indicate an hallucination or a drug reaction. The person is beginning to detach from this life and is being prepared for the transition so it will not be frightening. Do not contradict, explain away, belittle or argue about what the person claims to have seen or heard. Just because you cannot see or hear it does not mean it’s not real to your loved one. Affirm his or her experiences. They are normal and common. If they frighten your loved one, explain to him or her that they are normal.

3. RESTLESSNESS: The person may perform repetitive and restless tasks. This may in part indicate that something is still unresolved or unfinished that is disturbing him/her, and preventing him/her from letting go.

Your hospice team members will assist you in identifying what may be happening and help you find ways to help the person find release from the tension or fear. Other things which may be helpful in calming the person are to recall a favorite place the person enjoyed, a favorite experience, read something comforting, play music, and give assurance that is OK to let go.

4. FLUID AND FOOD DECREASE: When the person may want little or no fluid or food, this may indicate that the person is ready for the final shut down.

Do not try to force food or fluid. You may help your loved one by giving them permission to let go whenever he/she is ready. At the same time affirm the person’s ongoing value to you and the good you will carry forward into your life that you received from him/her.

5. DECREASED SOCIALIZATION: The person may only want to be with a very few or even just one person. This is a sign of preparation for release and an affirming of who the support is most needed from in order to make the appropriate transition.

If you are not part of this "inner circle" at the end it does not mean you are not loved or are unimportant. It means you have already fulfilled your task with him/her and it is the time for you to say "good-bye." If you are part of the final "inner circle" or support, the person needs your affirmation, support, and permission.

6. UNUSUAL COMMUNICATION: The person may make a seemingly "out of character" or unusual statement, gesture or request. This may indicate that he/she is ready to say "good-bye" and is "testing" to see if you are ready to let him/her go. Accept the moment as a beautiful gift when it is offered. Kiss, hug, hold, cry, and say whatever you must need to say.

7. GIVING PERMISSION: Giving permission to your loved one to let go without making him/her feel guilty for leaving or trying to keep him/her with you to meet your own needs can be difficult.

A dying person will normally try to hold on, even though it brings prolonged discomfort, in order to be sure that those who are going to be left behind will be all right. Therefore, you ability to release the dying person from this concern and give him/her assurance that you will be all right and that it is all right to let go whenever he/she is ready, is one of the greatest gifts you have to give your loved one at this time.

8. SAYING GOOD-BYE: When the person is ready to die and you are able to let go, then is the time to say "good-bye." Saying "good-bye" is your final gift of love to the loved one, for it achieves closure and makes the final release possible. It may be helpful to lay in bed with the person and hold him/her, or to take the hand and then say everything you need to say.

It may be as simple as saying, "I love you." it may include recounting favorite memories, places and activities you shared. It may include saying, "I’m sorry for whatever I contrib8uted to any tensions or difficulties in our relationship." It may also include saying, "Thank you for . . . "

Tears are a normal and natural part of saying, "good-bye." Tears do not need to be hidden from your loved one or apologized for. Tears express your love and help you to let go.

Although you may be prepared for the death process, you may not be prepared for the actual death moment. It may be helpful for you and your family to think about and discuss what you would do if you were the one present at the death moment. The death of a hospice patient is not an emergency.

Nothing must be done immediately. The signs of death include such things as: no breathing, no heartbeat, release of bowel and bladder, no response, eyelids slightly open, pupils enlarged, eyes fixed on a certain spot, jaw relaxed and mouth slightly open.

A hospice nurse will come to assist you if needed or desired. If not, phone support is available.

The body does not have to be moved until you are ready. If the family wants to assist in preparing the body by bathing or dressing, that may be done.

Call the funeral home when you are ready to have the body moved and identify the person as a hospice patient, also tell the funeral home that this is an expected death and that the patient’s physician for hospice care will sign the death certificate, do not call 911, nor should the police be called. The hospice nurse will notify the physician.

Mom may be around for years, and she may, yet, decide to end this existence tomorrow. In either of these events, she is, I feel, the ONLY one who has any right to make that decision, and she DOES have the right to support of her loved ones in whatever decision she makes.

Perhaps you’ll show your deep love for a parent or husband or wife, or child, by realizing that "letting go" is the most critical and most difficult step for both the dying person and the one remaining behind.

No account of this process would be complete without an important reminder that SOME people decide to live, and are denied that opportunity by the ignorance and arrogance of a medical profession that gives them drugs and surgery when prayer, love and simple foods and vitamins may do far, far more.

But, it is also true that the sick person may well believe that it is the drugs which he or she needs. I would not ever force someone to NOT take those drugs, no matter how much I might disagree with that approach.

The person who wants to die surely has the right to die, but the person who wants to live, surely has a right to the truth when it comes to treatments that can help a willing spirit overcome the frailties of the body!

Get more data by clicking here for information about Dr. Jack Kevorkian.

This part of this Viewpoint you may regard as speculative, but I happen to have a calm certainty about certain events during and after the transition from the moment of death.

First, the great majority of people on earth today have a firm belief in God and have some clear or cloudy understanding of a continued existence for the soul or spirit after death.

That continued existence takes many forms, but the point here is that the belief in SOME form of continued existence, even in today’s materialistic world, is almost universal.

There ARE those who claim that man lives but once, and that we are creatures made of mud and chemicals – with death bringing a permanent end. These are the people that say that man is an animal without a soul.

I reject that from belief and from personal experience.

Let me wind up this Viewpoint with an abbreviated version of the story of the death of my own mother, Milda.

She, too, had insisted that she would never put up with dying slowly, or becoming an invalid. She lived alone, in a small cottage by Lake Erie in Cleveland, Ohio.

I got the call, living in California, that my mother was in surgery, and that it looked very grave.

Again sparing the medical and personal details, I immediately flew to her side. She was conscious when I arrived. She had those tubes stuck down her throat, so couldn’t talk, but she wrote lots of notes to me – telling me where she had hidden various stock certificates and currency around the house. She had some important documents sewn into certain cushions, and some under the ice cube tray in the ‘fridg.

I was her only child, and we were very close. Of my six children, she was particularly close to my middle son, her grandson, Garth.

I had a very strong sense of her wishes about death when I arrived, and during the hours I spent with her I asked, in several ways, and several times, if she wanted to get better. Her answer was always "no!"

She knew that my son Garth was coming to see her within a day, and it was obvious afterwards that she stayed fully conscious and very alert until he got there. It was clear that she wanted to see him before she died.

After he had visited with her for a few hours, that night she slipped into a coma. The next day, as my son and I both sat by her side, it looked like there would be no change in her condition. The nurse told us that she might linger in that condition for weeks, or might die any minute.

I asked my son, Garth, to go with me for a cup of coffee. As we sat in the hospital cafeteria, not more than 15 minutes away from Milda, I explained to Garth that Milda was very upset because Garth didn’t want her to die. I told him that she wanted to die, and that his hanging onto her made it very difficult for her to leave.

It was not immediate, or even easy, but Garth came around during those 15 minutes. He understood that the greater love was allowing a person to have freedom and permission to pursue her own goals!

When we went back upstairs to see Milda again, she had passed away during that short time.

I have no doubt of her ability to be aware of Garth’s grief, and his desire that she stay among us living.

I have no doubt of her comfort at knowing, finally, that he had decided that it was OK for her to leave.

Now, without trying to be mystical, but also without trying to offer too much detail, I then also had no doubt about certain further communications I received from my mother, after the death of her body.

She had wanted her body to be cremated, and it was very clear to me that she stayed around me and the body until the cremation was finished.

It was also very clear to me that she was at the memorial service. The pastor of her church actually allowed me to conduct the entire service. He introduced me, but I took over and ran the entire memorial service – an ode to the joy of my mother’s life.

She was there!

I have no doubt about that. Bonnie and I sat by the lake, the lake beloved by Milda, Lake Erie, and did our own personal and private memorial service while we cast my mother’s ashes on the waters. That was when Milda finally left our space – with great joy for all three of us.

She had had a very comfortable and happy leaving from that existence. She was at rest with the world.

Don’t, for any minute, believe that your dying loved one cannot sense you or hear you. And, don’t ever think, for one minute, that the death of the body means an end of communications.

You may talk in a normal voice, to your loved one. You ought not to be angry or in grief at the moment of death, or after, because, believe me, the one departing has an immediate sense of release from an old and sick body, an immediate sense of freedom, an immediate sense of something far better ahead.

You wouldn’t want all those wonderful feelings to be interrupted by your own thoughts or words – telling your loved one that the death was a terrible mistake, and that he or she should not have died!

One of the most important cycles for any person is the act of saying "good-bye" to all who were important to him or her.

One of the most important things you can do for such a person is to give them your permission to leave.

Drugs and heroic medical efforts, unfortunately, can keep a body alive far longer than the spirit may wish. It is not an easy thing, necessarily, to die with dignity. While the great bulk of humanity will understand and agree with the thoughts in this Viewpoint, probably the great majority of medical doctors would deny their truth.

Both the body and the spirit have to arrive at that final moment of death in a state of peace with the world.

You have an important duty to help your loved ones pass from this existence into the next in a way that gives them the greatest comfort and peace at a moment that is very important to them and to you.

If you have some experience with what I’ve written about, I would deeply appreciate your sharing your experience with me.