The nursing home called without warning. “The plain English translation of what the nurse said stunned me,” my friend, Meg, told me later. “Did I want to call Hospice, keep my mother comfortable and let her die soon, or did I want them to get her to a hospital? I had to tell them that minute.”

Meg’s mother, Connie, is 95 years old, in good health for that age, although lately she had seemed a little confused and had lost 10 pounds. Pressed for a decision, Meg opted for the hospital. The emergency room people quickly determined that her mother was badly dehydrated, malnourished, and had a rip-roaring urinary tract infection. She had a slight fever, 99.5 degrees F.

“At 95 years of age, that’s about as hard as her poor little body could fight,” Meg said. “If you or I had a urinary tract infection, our fever would have been more like 102 degrees. I am so glad I decided on treatment. I would have lived with the regret that she died of something treatable. No wonder she didn’t want to eat. No wonder she was confused. That’s what fever and dehydration do.”

Medical science has progressed to an awkward stage. They can keep us alive but hardly living. It produces hard choices for caregivers, like the sudden, life-or-death decision that blindsided Meg. Is there a way to anticipate and prepare?

These questions are easier if the care receiver has a living will signed and notarized while she is in normal mental health. Meg’s mother had one that indicated she wanted food and water (nutrition and hydration), palliative nursing care, and pain relief if needed. Connie also had a Do Not Resuscitate (DNR) order. If she could not breathe on her own or if her heart stopped, Meg knew her Mom would want to die, not be shocked back to an uncertain state of health. Meg was influenced in her decision, as she should have been, by these documents.
But what if there is no living will, or even a DNR? How does a loving, well-intentioned caregiver decide what to do?

One basic consideration is what Meg stumbled on. Does my care receiver have a treatable condition? Are there signs of illness? Is there pain, swelling, bruising, or tenderness anywhere on her body? Is there evidence of stroke—slurred speech, weakness or inability to move arms or legs? Is there a sudden change in appetite or bowel habits?

 A second question may aid decision making. Does the care receiver have the stamina to withstand the surgery or other procedure that would help? If the care receiver is alert mentally, ask her to help you decide.

A third question is what is my conscience comfortable with? If I do not authorize treatment will I be troubled by this forever? Have I determined to reasonable satisfaction that nothing more can be done?

About the author

Martha Evans Sparks graduated from the University of Kentucky where she majored in journalism. She has master’s degrees in experimental psychology and in library science. She has written four books, one concerning dyslexia and the other three about various phases of caregiving. Check out Martha’s Journal and her books on caregiving on the web at www.martha-evans-sparks.com. Watch for Martha’s fifth book, Raising Your Children’s Children: Help for Grandparents Raising Grandkids, available wherever books are sold.