He is over 90 now, has not recognized the family for over 4 years. He is still given treatments for his diabetic condition and injections to encourage eating. Am I wrong to believe all meds should stop except to relieve any pain? I know he would not want to live like this. He is in an ALZ unit.
At some point it's not a matter of extending a person's life. It's about letting them go in peace, I believe.
As weight drops, insulin needs to be adjusted. Mom's daily readings were normal with an occasional low dip in the mornings. Even so, she started having morning episodes where her mind would completely go. This went on for months. Sometimes they lasted into the afternoon. We were told it was likely lack of oxygen by the nurse even though her oxygen readings remained normal. I finally remembered a doctor once telling me insulin needs to be adjusted with weight so I demanded a HbA1C. Her insulin was not just lowered...they discovered she didn't need to be on it at all! A day later, our Mom was back. No more mindless morning episodes. This may not be the same in your case, but don't assume they are tracking his insulin as his weight drops. Ask to see his last HbA1C test results.
Mom was in Palliative Care at home for 11 months, then transitioned into hospice the last two weeks of her life. She was prescribed a pill to increase her appetite, but it didn't work. We took her off all her meds in increments. It was difficult because we had to acknowledge she was dying. First the vitamins went, then her allergy and acid reflux meds. We consulted the Palliative Care doctor when it came to her thyroid and heart meds, and she was taken off them when she transitioned into hospice. The only meds we continued to administer and increase were for pain.
Recommend a heart-to-heart talk with his doctor.
- you can't not treat diabetes, as far as controlling blood sugars from day to day goes at least.
- you can not give an appetite stimulant.
Why? Because... [thinking aloud]
Insulin and routine blood monitoring are basic systems maintenance, not onerous for the patient, not heroic, but preventing extremely unpleasant symptoms. To withdraw these would be at the same end of the spectrum as withdrawing food and water.
An appetite stimulant, on the other hand, goes beyond routine care and by implication anticipates a future where the patient, having "got back to normal," will resume his previous habits. Since that is not going to happen, there is no benefit to the patient in having his appetite stimulated in this way. Mind you: stimulating his appetite in other ways, such as offering well-presented treats, snacks and drinks, is still worth doing because any potential enjoyment is of value to him in itself.
But in principle, no I don't think you are wrong to want all medication to be withdrawn unless it is of demonstrable, realistic benefit to the person *as he is now.* Where you might want to stretch a little bit is in relating the person's present condition to what he would theoretically have thought tolerable when he was fit and of sound mind. He isn't the same person now, and his personal red lines will almost certainly have been re-drawn.
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