Below is a link to a Hospice brochure which may answer some of your questions.

If you google "Hospice stages of dying" you will find more info.

Here is a link that might be useful: Hospice brochure

Thank you Maddielee for posting that link, I bookmarked it to read later.

Chisue, I understand what you mean about wanting to make your wishes known now while you can. My mom is 89 this year and for 12 years I have tried to get her to do this~~if she had been willing to talk with me through the years I would not be the overwhelmed and resentful person I am today. So much has happened in the last 10 years that has put me way out of my comfort zone and truely horrified me, because I did not know what to do and have had to do things I do not feel comfortable with and have really stressed me out.

We do have all of our affairs up to date, through taking care of my mom, we are learning that we need to sit our kids down together and verbally talk honest about what we want, and get there input as to what they will be comfortable with. I know my kids do not want to have the discussion of end of life affairs for their father and I, but in the end it will make it easier for them if we make our feelings known now~~the they are doing what we want not just trying to wing it in the end;(

Sorry did not mean to highjack your post~~I just wanted you to know I understand why you are asking.

Maddielee -- That brochure was helpful and beautifully stated. Thank you. However, it didn't quite cover medical specifics I want to avoid.

I called a hospice to which we have contributed from its' founding 35 years ago. It came into being too late for my mother's death. It's not the hospice we would use, but IMO it needs our contributions more than the one near us because of the population it serves.

The hospice director with whom I spoke provided answers to my questions. The POA I've signed isn't as specific as I want. It appears that I can modify mine (and have the changes witnessed). I don't want DH (or DS) second-guessing exactly what I DO NOT want.

Beyond the DNR's, I do not want my dying prolonged by being intubated; by dialysis; by hydration; by a feeding tube. I do not want to be hospitalized except as a hospice may lease space within a hospital to provide palliative care.

I'm relieved to hear that pain medication can be delivered via an IV *without hydration*, and that it can even be administered in liquid form beneath the tongue or applied to the gums.

I welcome comments or corrections on any of my plans or misconceptions.

I guess I've experienced dying as closely as one can without actually participating. Unless one is fortunate enough to make the journey during their sleep...in the middle of the night...as I hope to do when the time comes...being the only caregiver to my best friend and husband as he followed the long, winding path of pancreatic cancer complicated by a heart attack and several MRSA attacks that resulted in rampant sepsis...to his death...was more than I would have chosen to do.

But...that being said...the most important decision he made during his more lucid lifetime was to execute a DNR [do-not-resuscitate] order and filed it with all of his medical facilities as well as his Will and POA. That removed me, personally, from having to make any decision in the matter. It was the kindest act he ever made during his lifetime and I've executed the same order for those who may be left to escort me from reality. I would suggest it to anyone who's asking the questions you are, Sue.

My husband's final hours stretched to almost 72 hours and they were excruciating. He had directed that he be pain medicated to the max during his final hours and the staff saw to it per his written order. But in his final hours...no amount of morphine could still his pain. Nothing could have eased those hours. If I ever find myself in a similar situation...I would spend my last cent to get to a State where assisted death is legal. But that's another subject entirely.

Death did not come easily or quickly in his case. Having witnessed it many times, I can say from my own experience that if you're not a victim of a massive stroke or heart attack or some act that ends your life immediately...there is no time limit on how long it can take. I really don't think there is a "natural" death as you want to define it. It certainly doesn't appear so for any of us who guide the dying through their last days...and beyond.

I'd advise you to execute a DNR order if you haven't done so already...and...put your exact wishes in it. It is a legal document and it will be followed to the letter of your wishes without emotional complication. Additionally...if after you've executed it and had time to think about it...if you have a change of heart or need to add/subtract from it...you can always amend it....privately.

Anne

Thank you, Anne, and thanks to those who have sent me private messages. I've experienced and known of too many terrible endings not to try to avoid one for myself -- and not to try to spare my family.

The DNR isn't adequate. I'm hoping my more specific "Do Not's" will help. A Natural Death (AND) is being promoted by many in the hospice field.

There are several documents that you need, but I'm fuzzy on exactly what they are & exactly what each one does.

The Physician's Directive is one;
maybe it's got provisions for the other 'do nots' you're wanting.

& you need to have a heart-to-heart with someone who will take responsibility for medical decisions if/when you aren't able to make them yourself;
this person will hold your medical power of attorney.

Thank you for posting about these decisions we all should put into effect or update (ie, if your ex is still your power of attorney, medical power of attorney, heir, or life insurance beneficiary...).

I wish you the best.

Because you can't cover every contingency, I think just as important as the proper/legal paperwork, is the discussion with your family/next of kin regarding your wishes as your death approaches. If they can't do this discussion in an open, honest way, then perhaps they should not be included in the decision making. If they have a "general sense" of what your wishes are, then they can apply those principles if something happens that is not specifically addressed in the paperwork.

That being said, unfortunately sometimes prolonged painful deaths are unavoidable, even tho' all the bases were covered in the Living Will & Durable Power of Attorney/HealthCare & the family/next of kin are following the dying person's wishes exactly.

Things might be somewhat different in states where euthanasia is legal. I can't really speak to that.

It's whatever you decide it is. I can't think of anything more appropriate for you to have "your way". Decide what you want and spell it out for your family and health care providers to know. Good luck

Here is another excellent website which I have referenced many times when I was the full time caregiver for both of my (now deceased) Parents

http://hospicenet.org/

Here is a link that might be useful: HospiceNet.org

katclaws -- Thank you. That's a nicely arranged site, with a easy-to-find information headings. I have to go back and read more closely.

Your parents were fortunate to have a DD to not only provide care, but be 'on guard' for them. Did you have to say no to any medically advised 'interventions'?

my mother went on hospice and was given pain meds but nothing else when she slipped into what I'd call a twilight sleep, and passed away a mere 3 days later...I think once she knew her condition, (still to this day not sure other than heart) it released her....my grandmother on the other hand, didn't seem to want to let go, and drs were amazed she lasted as long as she did....
mother did request cremation (as did my father) and no service...my kids were a bit vocal about that, but then they weren't there! their dad and I are doing the same thing....

fil is fighting yet doesn't want the proper care...and (as of last night) is back in hospital...he had fought going to nursing home, and we have no recourse as dh doesn't have the "right", only dr can release...(per fil directions) so our hands are tied...
these are just a few things to think about...Blessed day for you....

My Dad fought the Nursing home thing too and ranted and raved so we told him he had to be transferred to another hospital and he never even knew he was in a nursing home...

He wasn't mentally all there at the end and never quite associated the nursing home as anything except another hospital...

We just went through all of this with my parents wills and the other forms that the lawyer prepared for their trust. They both requested no extraordinary measures and no nutrition but hydration on the advice of my husband who said that dying of dehydration is very unpleasant.

I suspect taking longer TO die because you are hydrated is unpleasant, but will defer to the medico's. Which reminds me, do we have any source to know what MD's and others with 'inside knowledge' choose for themselves?

I hope you don't mind a sometime-lurker chiming in. My understanding is that each state and country has slightly different laws/regulations governing living wills, health care powers of attorney, etc. I know someone whose father had an old living will that had been prepared in FL. The father had a very serious traffic accident in GA, and the family had quite a time with the hospital and doctors during the days his father was unconscious. At one point the hospital staff refused to talk with his mother about her husband's condition.

Be sure that your living will is compatable with your state's (province's) laws---current laws. It's important to check your documents periodically to be sure they're correct and to indicate in writing the date of review.

This link is an interesting article about how doctors choose to die:

Pat

Here is a link that might be useful: Why doctors die differently

What a great post! It's not something anyone wants to talk or think about but it's probably the most important decision one can make.....

My hubby and I both have our living wills but I'm thinking I need to do some adding....

When my late Mom was admitted to the hospital the last time, the doctor met with me and kept assuring me everything would be done to keep her alive! My Mom had a living will but it was left at the nursing home and the doctor in ER told me, he had talked to her and this is what she wanted....Knowing my Mom, this was the last thing she wanted...I told him, he'd better ask again and he needed to speak very loud because of her lack of hearing...Well, when he asked if she wanted to be kept alive, she took that oxygen mask off her face and very loudly, told him NO...With that, he turned, left the room and we didn't see him again.....My Mom drifted from awake to coma and back again for almost a week...There were times, when she wanted ice cream and actually ate some and we were able to talk...She passed away the following Sunday morning, very peacefully in her sleep....I feel she did it her way........Sorry didn't mean to go on and on.....

Excellent article, Pat.

In my expeirence with 1st DH...natural death is no drugs to treat the disease, except for pain meds, if requested.

Everybody, please click on the "Why Doctors Die Differently" & read the whole thing.

It's an eye-opener.

Thanks for the link, iread06. That's pretty much what I'd thought. I suppose we aren't going to read any printed references to medically assisted suicide, although an MD could quietly manage it.

I recall reading that in states where assisted suicide is legal, very few of the dying actually used the fatal meds they had available to them. The story indicated that it was enough for many just to know they had control of that option.