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There is more to this than meets the eye. Is the patient eating a proper healthy diet? Does she become extremely combative when her blood sugar is checked or she sees the Insulin syringe coming? Is her diabetes reasonably well controlled with oral medications? Can she still get up and walk around and exercise? Are they, who ever they are, hopefully the MD, proposing stopping all medications except for pain and anxiety? This is a complicated situation not just a question of should the Insulin be stopped. Could you give us more background on this lady. There is not a simple yes or no answer to this question.
Another consideration is the behavioral problems and morbidity that goes with wildly fluctuating blood sugar. It's not just a simple fading away. My mother is diabetic and I wouldn't want to go through that. If she wanted to do it, she would have to do it out of my sight.
mj1364, I suggest you google "Diabetes Management Decisions in Hospice." You will find interesting clinical information.
POA does not give one authority to make medical decisions. Medical Proxy, aka Medical POA, does. I really can't tell you what the range of "legal" decisions is.
How do you know that discontinuing insulin would result in death in several months? Or that on insulin the person would live several years? Is this person type 1? As a type 2 I am taking insulin (and also other drugs) to try to prevent long-term complications. I would not die without the insulin. Unmanged glucose level could eventually lead to limb amputation, blindness, and other complications. If I were to go on hospice, with an expected life span of 6 months or less, then trying to prevent long-term complications wouldn't make sense, and I'd rather do without all the poking and prodding and expense and discomfort of the diabetes regimen.
Is the dementia in its final stage? The fact that you think the person could live many years seems to imply no. And yet it is severe enough that death seems preferable. Who has given a prognosis of many more years?
mj1364, people's attitudes and beliefs are all over the map on questions of assisted suicide, hastening inevitable death, reducing suffering,death with dignity etc. Do you know wishes of the person who has dementia on these topics (before dementia showed up)? I think that would be more important than your own views at this point.
I know my own views but I try very hard not to judge other people's decisions in these matters. To protect yourself, I suggest that you proceed under the guidance of a doctor and/or hospice.
If the person could live for years if they have insulin, then the only call is continuing the insulin. Calls about discontinuing a medication are only made if death is near, so that the drug does not contribute to anything meaningful. The only person who could legally decide not to take insulin would be the person themselves. Even a person with a healthcare proxy or guardianship could not decide to do this. Could I ask whose idea it is to withhold the insulin, which will bring about a faster death? I don't think doctors would even touch this idea.
Oof. Withholding insulin... I can't see the patient's doctors agreeing to that. It would be a deliberate omission leading to a predictable outcome of death; almost equivalent to withholding food. It would also be a very unpleasant way to go, wouldn't it?
Have you actually broached this idea with anyone, or did someone suggest it to you?
NO, you should definitely NOT discontinue the Insulin on your own, or without DR supervision! The patient could become severely ill with GI symptoms, and also go into a diabetic Coma, do you really want this sort of death at your own hands? You would be KILLING THEM, IMO!
I don't believe it's up to you, but up to the patients Dr's! I think you will find that most Drs will be happy to decrease meds in the elderly, when they no longer seem nessasary, especially meds like cholesterol control drugs, but LIFE SAVING DRUGS, No, I wouldn't suggest doing that on your own! Asking the Dr about getting Hospice involved and helping you in the home or in a senior facility, then those life savings drugs would be stopped appropriately, and comfort care only medications would be kept in the patients arsenal. You don't want to be accused of any wrong doing.
I would place loved one on hospice care, if loved one qualified.
I would ask the prescribing doctor to consider discontinuing the drugs, and explain the reason.
I would be careful to distinquish between "life sustaining" (which would include very few drugs, I believe) and "life enhancing." Discontinuing a drug which merely intends to relieve anxiety, for example, may not achieve the desired results.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
This is a complicated situation not just a question of should the Insulin be stopped. Could you give us more background on this lady. There is not a simple yes or no answer to this question.
POA does not give one authority to make medical decisions. Medical Proxy, aka Medical POA, does. I really can't tell you what the range of "legal" decisions is.
How do you know that discontinuing insulin would result in death in several months? Or that on insulin the person would live several years? Is this person type 1? As a type 2 I am taking insulin (and also other drugs) to try to prevent long-term complications. I would not die without the insulin. Unmanged glucose level could eventually lead to limb amputation, blindness, and other complications. If I were to go on hospice, with an expected life span of 6 months or less, then trying to prevent long-term complications wouldn't make sense, and I'd rather do without all the poking and prodding and expense and discomfort of the diabetes regimen.
Is the dementia in its final stage? The fact that you think the person could live many years seems to imply no. And yet it is severe enough that death seems preferable. Who has given a prognosis of many more years?
mj1364, people's attitudes and beliefs are all over the map on questions of assisted suicide, hastening inevitable death, reducing suffering,death with dignity etc. Do you know wishes of the person who has dementia on these topics (before dementia showed up)? I think that would be more important than your own views at this point.
I know my own views but I try very hard not to judge other people's decisions in these matters. To protect yourself, I suggest that you proceed under the guidance of a doctor and/or hospice.
Have you actually broached this idea with anyone, or did someone suggest it to you?
I feel your pain in trying to make these decisions. Call hospice. There is great wisdom therein.
I would ask the prescribing doctor to consider discontinuing the drugs, and explain the reason.
I would be careful to distinquish between "life sustaining" (which would include very few drugs, I believe) and "life enhancing." Discontinuing a drug which merely intends to relieve anxiety, for example, may not achieve the desired results.