"Soylent Green" is people

The first part of Fast Eddie Rendell's plan for an 'Improved Death' is to be sure that all 'Rat voters about to check out be SURE to update their voter registration information, because they wouldn't want to miss out on any future elections after they've departed this mortal coil, now would they?

That's probably the MOST important part as Rendell sees it.

I wonder if he'll have slot machines installed at the hospice facilities - just so he can see those seniors' faces light up as they pull that lever one last time.

Ed Rendell is nothing if not pro-death.

Except when it comes to the actual death penalty...

I'll need to review this all very carefully, as I am taking care of my aging mother. And it would be my aim to protect her from the state.

I wonder if any of the proposals call for dehydrating people to death.

I hear its euphoric and makes one look beautiful.

death was more impersonal and painful than it needed to be.

So give them pain meds and hold their hand.

My mother-in-law suffered from OPCA, a degenerative disease of the nervous system. It had symptoms similar to ALS and was related to Parkinson's in that a particular part of the brain was becoming atrophied (the "pons" in olivopontocerebellar atrophy).

Over the last nine years this disease took away her ability to walk, talk, toilet herself, and eventually sit and swallow. She may or may not have been aware of how bad she was; it was hard to judge. Her heart and lungs were strong and she was well cared for at her apt by her son (my husband) and a wonderful paid care-giver ($700/week for the caregiver, plus rent and living expenses for my MIL).

For whatever reason, even knowing the eventual outcome of her disease, she and her son never discussed frankly her end of life care and what her preferences for the end would be.

When the loss of the swallow reflex caused her second bout of aspiration pneumonia she entered the hospital never to come out. She was in for over 70 days, most of them on a respirator. She had an ng tube for feeding. It was about the worst end you can imagine. My husband did not know how aggresively she wanted to be treated and agonized over every care decision from the 2nd day when they wanted to put her on the respirator to the last week when they wanted to put in an adominal feeding tube. She couldn't go to hospice without the feeding tube, she couldn't be totally taken off the respirator, and she was taking up a critical care bed and all its monitoring and skilled nursing care with no chance of recovery or a good outcome.

Everyone tried to determine what she wanted, but she couldn't squeeze her hand on request, though she responded to my husband and her care giver when they entered the room. My husband tried to communicate with her, so did her doctors and various member of the ethics board of the hospital. She only lapsed into a coma in the last 24 hours, she was conscious almost the entire time.

Medical technology can extend life well past its natural limits. ANYONE can end up in a situation like hers and it is not fair to expect your loved ones to try to make these awful decisions with no input from you. If my husband knew that she would want aggressive life extension, he would have done it. If she clearly stated no heroic measures he would have done that too (no respirator, just palliative care). It was a terrible burden for him, his mother's life or death, and he was an only child.

Its time to bring this uncomfortable topic to the table so there is no misunderstanding. My MIL's care cost the insurance company, medicare (and thus the taxpayers) a small fortune. Her home care was close to depleting her own resources too, there was probabaly only enough for 1 more year max of the private care-giver and homecare.

I think PA is on the right track.

Just wished that Fast Ed would be the first one in line to try it out. Install slot machines! He'd probably try. Wait 'til his announcements tomorrow! State sales tax up to 7% (Pitts. and Philly 8%) and something about electricity rates! Hang on to your wallets. No wonder everyone is moving out of the state.

Pinged from Terri Dailies

8mm

The joke at lunch today was whether Sheetz would be installing slot machines - and would they be called Slotz Machinez.

We here in PA deserve every bit of it - we KNEW d*mn well what we were getting when we re-elected this guy, and by an overwhelming majority.

Apathetic bloody planet. I've no sympathy at all..

http://www.philly.com/mld/inquirer/business/16619625.htm

Rendell has been awfully busy lately. Yesterday he hinted at raising the sales tax to 7% to lower property taxes. Apparently we will get the 411 tomorrow. Does anyone know about this proposal?

This new 'death plan' is to assure libs of votes in the future....

I live in Southwest PA. I can assure you that 9 out of 10 people living here is a union zombie. They WILL follow their Demorat/union leader right of a cliff. It is truly Maddening!

I live in Northwest PA. I can assure you 9 out 10 people here DON'T have a job (except at Presque Isle Downs, which is supposed to open Feb.15). Now they're saying that might be delayed becaused of the Gaming Board. What a crock. Next election, we should go to the bullet box, not the ballot box.

It's time to bring this uncomfortable topic to the table so there is no misunderstanding.

We have been there three times: once with an angry parent who did not want to think or talk about such decisions, once with a comatose parent who could not think about such things, and once with a parent who had though it through and clearly communicated her wishes.

The latter died in home hospice, and despite the fact that hers was the slowest death, it was by far the “easiest” and most dignified.

Now we are down to my mother, and it looks like we are back to “Don’t want to think about or discuss it.”

It’s HARD to get people to think about such issues – as this thread attests.

'Cause as someone once said: “The problem with the American way of death is that the Average American thinks he is going to die peacefully in his sleep at 94, after beating is son at tennis that morning and then going home and making love to be wife, twice...”

Really?!! Here in the Mon Valley there are Help Wanted signs in a lot of the businesses. It's actually starting to grow here a bit. I didn't know the economy was that slow up north.

We were always "heavy" in manufacturing. Just in the last few years - International Paper- gone 850 employees: Steris Corp. - gone 450: Blair Corp - 150 : Rent-Way - 140 and on and on. Since 2000, we have lost 25% of mfg jobs, mostly due to high taxes and ding dongs in office ( which is our fault) It seems ding dongs rule the Commonwealth. It really is disgraceful.

Under a national health care plan like Hillary care the demand for such end of life care could increase as budget constraints will mean that some will not be treated for their serious maladies (the very young and the elderly)and certain "heroic" measures like liver transplants will be denied as too costly.

I wonder if any of the proposals call for dehydrating people to death.

Legislation just went into effect in PA a few days ago which makes it easier to starve and dehydrate incompetent individuals, with or without their consent. It bypasses the court system, and streamlines the process.

Act 169. Enacted by Senate (SB 628) Nov 19, 2006. Signed by Gov. Rendell the next day.

You are absolutely right. After watching my MIL this past spring I have come to realize that a "good" death is indeed a rare blessing.

My mom has made her wishes clear, and she has signed medical proxies and a living will. She went through this, but not nearly so bad with her dad. He felt ill and entered the hospital on Monday and was gone by Wednesday. He was 96. The doctors wanted to insert a pace maker and perform other invasive procedures. She gave consent for the first thing, but he was so scared and confused, without his eyeglasses and hearing aid and unable to see, hear or understand what was going on. While 96 good years and two bad days isn't bad, he could have had a more peaceful end time with us if the doctors would stop this heroic effort for very old or very ill patients. The concentration should be on palliative care. You have to ask the docs, "Would you give consent if it was YOUR dad?"

My mom tried to talk to my husband while he agonized over his mother's end of life care, but he was truly conflicted. My dad on the other hand won't put anything in writing and is uncomfortable talking about this. It is a very selfish attitude and a tremendous burden to put on your spouse or children, trying to guess what you would want.

I did a medical proxy, but did not make my husband the designated decision maker. I don't think the can judge clearly and the pain is still way too raw for him. His dad had a miserable last 110 days in the hospital following a major stroke 20 years ago. I designated my mom and then my oldest child.

I did a medical proxy, but did not make my husband the designated decision maker. I don't think the can judge clearly and the pain is still way too raw for him. His dad had a miserable last 110 days in the hospital following a major stroke 20 years ago. I designated my mom and then my oldest child...

The doctors wanted to insert a pace maker and perform other invasive procedures. She gave consent for the first thing, but he was so scared and confused, without his eyeglasses and hearing aid and unable to see, hear or understand what was going on... he could have had a more peaceful end time with us if the doctors would stop this heroic effort for very old or very ill patients.

110 days! No wonder the pain is "still raw", here's something I wrote a few years back after my FIL had a series of strokes and had hospitalized for only around two weeks.

I don't know if still feel as "adversarial" toward the medical system as I did then, but my basic opinions are unchanged:

--------

"Well, here's were we are this morning: trying to get my FIL moved to the hospice Monday. He's mostly non-responsive, even when awake doesn't know us, is not able to communicate any changes in his desires since the singing of his living will in '93, and for more than a week he has been refusing all oral food and water.

When we arrived Friday night he was strapped to his bed to prevent him from pulling out the IV's and catheter, and his primary care physician was suggesting we start feeding him through a tube in his stomach to determine if improved nutrition might return him to a more conscious state.

My wife, my MIL and I reluctantly (because it would be to some extent thwarting his often expressed wishes) agreed between ourselves that we owed him this last chance for a meaningful life provided that we could suspend tube feeding if there was no improvement.

From that point on things began to get pretty wild, and before the weekend was over we almost lost control of his treatment to the health care system even thought there had been no change in his condition nor any "emergency", this as a result of the attending physician's repeated assurances that we could unconditionally suspend such efforts if we wished: that we could "ask to have the feeding tube removed at any time".

My wife was willing to accept this assurance, but based on what I'd read, and the horror stories I've heard, I was extremely uneasy.

And the longer I thought about it Friday evening the more uneasy I became.

As a result Saturday morning, before the hospital visit to give the OK, my wife and and I had one of our very infrequent knock-down drag-out arguments over my distress and distrust, a confrontation not improved by my having nothing but a strong conviction that something was very wrong, that irrespective of what this doctor was saying, I know this feeling from business, and when I've felt it it's sometimes just before the rug is pulled out from under me by someone I'd always trusted.

To which my wife replied with complete justice that I was hardly being rational, that I really tended to push people and organizations way too hard, and that she did not want to get into an adversarial relationship with the hospital, or the attending physician (whom we had all trusted and relied on to this point) as a result of my attitude.

And by the time I got to the hospital, I had half convinced myself that my concerns were unreasonable, that I was just reacting baldly to the stress, and that I was being out of line.

And it wasn't until it looked like she was going to go ahead despite my concerns that I realized I did have an independent resource she also trusted to evaluate my unease: the attorney who had been advising my in-laws on financial matters.

I gave the attorney a call from a pay phone, heard what she had to say, asked her to call back, and made sure my wife took the call when she did.

The lawyer's message was very clear: "I don't think you will have this control, and my advice is that you get advance written assurance that you do from the hospital administrator if you feel it may be required".

With this in mind my wife called the attending physician back, only to discover that he suddenly didn't really want to discuss the matter with her further, but instead referred her to the surgeon who would implant the tube.

Who, once we had reached him, was also very clear: "It wouldn't be that simple. There would be moral, ethical and legal issues involved".

So, she called attending physician once more, asking, and continuing to ask, questions till he came clean: once the decision to start such life support was made she could indeed "ask" to have it ended at any time. But the decision would be out of her hands, made by the hospital administration, and any attempt to second guess their decisions might well have to be made by the courts!

So, there we were - that close, with the best of intentions, to having left him strapped down to a bed with god knows how many tubes coming out of him, thwarting his wishes and ourselves possibly helpless to control the course of his treatment and the nature of his death.

IMO, the moral is:

I. Make sure you have an properly executed durable power of attorney for health care, and that the power is delegated to someone with enough intelligence, tact, time, patience and skepticism of authority to insure that your wishes are executed.

(And please understand, I'm not trying to paint myself as the prefect candidate. Had the roles been reversed and it been my father my wife might well have been the one with enough distance to be the skeptic, and I the one perhaps too willing to accept a way of putting off the decision).

II. Do not assume that the hospital staff are "on your side". At best they have divided loyalties. They work for a large, bureaucratic organization, with lots of rules and regulations, mostly designed to protect it from the possible consciences of it's actions. A bureaucracy LOTS more worried about review from regulatory bodies than about the results of frustrating or misleading individual patients.

III. On admission you will be handed a nice pamphlet outlining your "patient rights". Keep in mind that these are equivalent of the rights read you by a homicide dick: the rights, and only the rights, you have the resources to enforce in court.

IV. Thus it appears that this country you can't even die without the assistance of a lawyer. And IMO, you are running a big risk if you do not have independent legal advice at every step of journey.

V. Make sure that you understand exactly how much control you have of treatment, and especially of the withdrawal of treatment. Unless it's an emergency situation, don't sign anything, no matter how routine, or how high the staff's level of apparent conviction that it is routine, unless you are certain you completely understand it's possible implications.

Be politely persistent, but commit yourself to being certain of the hospital's objectives, which may not be yours. And if you are not certain you have such an understanding, tell them you need to sleep on it, and get a lawyer to review it.

VI. Realize that the advice and information you are receiving from the doctors, nurses, social workers and others associated with the hospital is possibly no better than that supplied by anyone else with a product or service to sell you - that it may not reflect respect for your wishes and priorities, or may not be accurate or complete.

IMO an appropriate mindset when dealing with any doctor, nurse, social worker, or ethical adviser provided by a hospital is that of a POW in the camp infirmary: ethical considerations, professional habit and outside oversight will dictate that you receive some kind of care. Ideological, political, ethical or moral differences between yourself and your captors can mean that the staff (perhaps without even realizing it) may place their priorities ahead of yours.

V. Never express any of these concerns to the hospital staff, probably most are attempting to act ethically, at least in light of their understanding of their objectives and responsibilities.

Be polite, and try to understand the motives and concerns of those providing your care.

Be openly and frequently appreciative of the services they provide under difficult conditions.

Keep your temper.

Be reasonable.

But don't trust anyone."

The personal and family dynamics of this stuff is really complicated, and often really painful - one of the things that strikes me more and more forcefully as I get older is that intelligent, reasonable, compassionate people who’s opinions I respect can have radically differing opinions about such matters, and that even deeply held opinion can change with experience.

My MIL for example, was very strongly in the “keep me alive no matter what” camp, even after having watched watch my FIL’s prolonged death.

But a decade later, after a long battle with CHF, she elected to forgo further hospitalizations for supportive treatments and entered home hospice – she was just sick of the repeated hospitalizations, and refused to go though the experience again.

And there are frequent examples of people who go the other way.