OT: End of life, Family conflict, damned if you do and if you don't, thought?

[FlashUNC]

This sucks.

Huge difference between being alive and living though.

I'd bring it up if the BIL is pushing hard about it in family meetings. The Physician's Directive was put in place for a reason.

[Climb01742]

Can you find a third-party to mediate and/or give an impartial POV on 'what's best' for your FIL? Is your family religious? Is there a trusted lawyer? A doctor or social worker everyone might listen to? Even a friend of your FIL?

Family dynamics can help...and at times, hinder. Could an 'outsider' help everyone find common ground by moving outside the family dynamic?

A few years ago, my mother had a very bad car crash. While in the hospital, she 'died' twice and was brought back. Fortunately, we had discussed everything and agreed on a third-time do-not-resuscitate. It was a very difficult moment with the doctor while we discussed whether to follow through on our agreement, but I knew it was my mother's deeply held wish to not be on life-support or undergo extreme measures or a degraded QOL.

You have my sincerest sympathies. Without a doubt, it's agonizing finding the right path.

[AngryScientist]

If the hospital is sizable they will almost certainly have a social worker who can assist.

You can avoid the direct confrontation, and even act somewhat anonymously. talk to the social worker and possibly a hospice representative. they do this type of thing every day and know how to make people better understand the reality of the situation.

[572cv]

My father in law died on Monday night. Also a victim of a long running battle with dementia. It turns out there are at least a few kinds of dementia, Alzheimers and vascular. He had what appears to have been vascular.

All I can offer is this: The hospital, and books we have read, told us that when the patient stops eating, it is the body saying that it can't process food properly any more. Force feeding the patient at that point is cruel. It leads to bloating, to intestinal tract problems and discomfort. At least this is what I understand. One should offer food, drink, but not force it. It is a talking point with your family at least. Do those who want to prolong life understand the risks and possible painful conditions in the aftermath?

We also had a directive from my wife's father. No heroic measures. I am grateful that the family respected this. I think that this is a key measure of respect, to respect the directive. If that is what was wanted, honor it. I know it is difficult, but in the presence of a directive executed with sound mind and body, it is not yours to change. For my wife's father, the hospital was all about it. It was posted all around. Make him comfortable but no heroic intervention. He died peacefully with family around him. He had a tough last few years. It was a gentle exit, all anyone could hope for.

My best wishes to you in this difficult and emotionally fraught time.

[OtayBW]

Following are the salient points as I interpret them:

Originally Posted by Kirk007

On the one hand we believe her father to be suffering and her brother's conduct, while in some ways understandable nevertheless is inhumanely selfish and contrary to his duties as Guardian to do what is in the best interests of his father.

His conduct is deepening the gulf that already exists between him and his sister, and me and other family members.

i) If we say nothing, father-in-laws suffering may continue through the "miracles" of modern medicine.

ii) If we confront, even gently and with kindness, brother-in-law, the likelihood of him hearing and reconsidering his path is remote. Far greater is the likelihood that he lashes out even more at the family and the family relations deteriorate even further.

And my conclusion, if I was placed in your shoes: Your responsibility and obligation is to help your father-in-law and limit his suffering. That is first and foremost, IMO.
Salvaging or maintaining any relationship with your brother-in-law doesn't even run a close second.

Easy for me to say....
Hope this helps, and
Good luck.

[Ralph]

In addition to what others have said....the hospital probably has some people on staff who can consel with family. Involve Dr, etc. They deal with this difficult issue all the time.

I went thu this a few years ago. Mom finally died of a UTI. After breaking a hip a couple years earlier. Difficult times.

[Ray]

I've been through it with two parents and a FIL. I would say that the angels are on your side even if the law is with your brother in law. And the bottom line is that NOT saying anything to him will damage the relationship between the BIL and his siblings and siblings in law every bit as much as trying to talk to him. It everyone approaches him kindly, clearly explains that you know his heart is in the right place, but that you think he's only prolonging his father's suffering, it might make a difference, or it might not. But withholding that advice isn't gonna do anything to improve relations over anything but the shortest of terms, and probably not even then. If he get's his way and the FIL lingers and/or suffers longer, everyone will feel incredible guilt for not pushing the point. He needs to be reminded this is about his father's wishes, which it sounds like he was clear about when he was of sound mind, not the son's sadness at facing the inevitable.

As others have said, when the person stops eating, it's the body shutting down - your BIL needs to understand this, whether you tell him or enlist the help of a doctor or hospice worker who's seen it a million times. It's usually not a willful choice - it's a lack of appetite and difficulty processing food. I think each of his siblings needs to talk to him about this, individually or collectively. Ultimately it may be his call legally, but each sibling has an equal moral and ethical stake here and no good will come from withholding strongly held advice.

-Ray

[Hilltopperny]

Very tricky situation. I would personally ask for a mediator and or grief counselor. They have people that specialize in these matters in every hospital. Everybody should take turns in expressing their feelings about the situation uninterrupted and then they can get there point across.

When I was 15 years old my father was misdiagnosed and ended up dying after a couple of weeks in the icu at Vassar and then Albany med. It was the worst thing in the world to see him suffer the way he did and I was honestly relieved when he did pass. Nobody should have to suffer unnecessarily.

Everybody copes with these situation differently and it sounds like he is having a difficult time understanding what his father is going through. It also brings up the fact that we are all human beings with a finite amount of time on this plane of existence. We start to question our own mortality which can be very unsettling and we may act out as it sounds like your brother in law is doing.

Hopefully you can all resolve your issues and when your father in law does pass it doesn't end up in a broken relationship between your wife and her brother. Good luck and hope this situation works itself out.

[Ken Robb]

This might be a good time for a clergyman or woman to offer counseling tlifeoo.

Has BIL spent any time with Dad over the past couple of years? Can he believe that any extension of life now would be enjoyable now?

I decided that for all practical purposes my dad was so far gone with dementia that he was "dead" a few months before he succumbed to pneumonia. On a visit on Easter Sunday I dropped by his care facility. Dad was having food spooned into his mouth by a nice nurse but clearly not enjoying it. I sat next to him and spoke, touched his arm and he didn't even know I was there. He hadn't recognized me in over a year.

If this is similar to your FIL's condition you might ask BIL to explain how more of this life can be fun for his dad.

Maybe he doesn't want to feel like he "killed" his dad. If all interested parties wrote a nice letter to BIL stating that they love FIL really felt like following the directive was best for FIL maybe he would feel relieved of the awful responsibility?

Medical folks can chime in but between FIL's dementia and drugs I doubt that FIL will know/feel anything anyway.

[gasman]

Lot of good advice here for a terrible situation. Getting a neutral third party involved is key. Whoever you can find that communicates well with you guys and your BIL. A doctor, nurse or social worker may be able to help open communication. I've seen some very good social workers that seem to be able to handle this role. It won't be easy. I think your BIL has so much heat because he's losing his Dad and he doesn't have the emotional maturity to see beyond that fact. He is showing that he is desperate to hang on to his Dad no matter what and can't see what's best for his Dad. A third party may help him understand how wrong it is to keep pushing. Nobody lives forever.

You and your family need to be able to communicate with your BIL how you feel, that's why a third party may be the best way.

Your FIL is suffering but, if his dementia is that bad he may not have the awareness, except vaguely, that he is uncomfortable. So that's a small positive in a hugely lousy situation .

Best of luck.

[wc1934]

Man, I feel sorry for you and your family. As some have stated, there is no correct answer. Just try to support your wife/family as best you can.
I wish you well.

[Aaron O]

This obviously won't help the OP, but I am not my wife's POA for this issue, her best friend is. I thought it best to have this decision, made in accordance with her wishes, in the hands of someone a little more removed.

She is mine...she's told me multiple times she'd have no problem pulling the plug on me.

[54ny77]

Horrible situation. Been in similar.

I'm assuming there aren't any estate planning shenanigans going on that are prompting this life extension. While I hate to even suggest it, having seen that ugliness happen before, you or a relative that's authorized might look into it if there's a designated estate attorney in the mix of it all.

You & your wife do what you think is right in your heart, for you & your father in law.

Karma will work its miracle on that other family member.

[Tony T]

Sometimes its hard to let a loved one go.
This is especially hard if you are the one designated to make the decision.

[Pastashop]

Lots of good advice and positive vibes, to which I add my sympathies. (Bought a bike from 007 and had a great interaction.)

Having a chat with a person specializing in matters of religion / psychology / social work is probably the way to go here, because pure reason is clearly out of consideration for the BIL.

Also, for what is worth, I read this quote recently and found it somewhat uplifting actually:

RIP utilitarian philosopher Derek Parfit: “When I believed the non-reductionist view [of personal identity], I also cared more about my inevitable death. After my death, there will [be] no one living who will be me. I can now redescribe this fact. Though there will later be many experiences, none of these experiences will be connected to my present experiences by chains of such direct connections as those involved in experience-memory, or in the carrying out of an earlier intention. Some of these future experiences may be related to my present experiences in less direct ways. There will later be some memories about my life. And there may later be thoughts that are influenced by mine, or things done as the result of my advice. My death will break the more direct relations between my present experiences and future experiences, but it will not break various other relations. This is all there is to the fact that there will be no one living who will be me. Now that I have seen this, my death seems to me less bad.”