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A dirty secret in eldercare is that many more people pass on as a result of euthanasia than you might think. End of life for people with dementia often results from "failure to thrive," a code word for not giving them food or water.

The symptoms of dementia begin to wear families down long before grandpa or grandma gets put in the old folks home.

Usually there have been years and years in which things weren't just right. Maybe the family member spent a lot of money on ill-advised investments. Maybe he or she felt compelled to give away treasured objects that were supposed to go to the children. People who have Alzheimer's or Parkinson's or Lewy body disease may be given drugs that make them hypersexual, and lack the judgment to comport themselves with dignity in the general public, with the family, or in situations that can get them in trouble with the law.

And the tragedy is that in their lucid moments, these same people may say that they would rather be dead than to live in long periods of dementia punctuate by short periods of utter embarrassment. Compounding the problem is the fact that taking care of people with these kinds of problems is financially ruinous. Not only do they run through their life savings, their children do, too. Tensions between siblings almost always ensue.

What's the ethical thing to do?

The Convenient Fiction of "Failure to Thrive"

In the United States, the inconvenient elderly often reach a point that they cannot or do not eat or drink. Not eating leads to slow wasting of muscles, which leaves the elder bedridden. Not drinking is a much faster way to go. You can be taking daddy out for barbecue one day and he may be dying of dehydration the next. The only way to treat dehydration is with an IV. Just about any nurse can give one, but you aren't going to get one in a nursing home. You have to go to the emergency room of a hospital for that. The nursing home won't take your loved one to the hospital for that IV. You are going to have to get an ambulance, and pay for it. 

Your pop is rehydrated. He's lucid. He's using words like "otolaryngology" in sensible conversation and complimenting the nursing aides in two appropriate foreign languages, one of them Czech, which seems to take a lot of brain cells. He's asking to see the old home place and say goodbye. Your sibling doesn't want him to leave the nursing home to take a look, so you can't take him. Calls to lawyers take place. Your father becomes depressed. He won't drink. The nursing home won't make him, and you're getting a call asking you whether to let your parent die or take him to an ER again two days later. And another time two days after that. And another time two days after that.

The Convenient Fiction of Failure to Thrive

Many families resolve these kinds of dilemmas by (1) slapping down disagreement in the family with legal action and (2) instructing the care facility to maintain life with hand feeding only under an order of hospice care. Then, when the family member dies of starvation or thirst a few agonizing weeks later, the cause of death is conveniently labeled "failure to thrive." They just didn't make it. Gee, we don't know why.

Continue reading after recommendations

  • inucane, T. E.
  • Christmas, C.
  • Travis, K. (1999). "Tube Feeding in Patients with Advanced Dementia - A Review of the Evidence". JAMA. 282 (14): 1365–1370. doi:10.1001/jama.282.14.1365. PMID 10527184.
  • Gillick, M. R. (2000). "Rethinking the Role of Tube Feeding in Patients with Advanced Dementia". New England Journal of Medicine. 342 (3): 206–210. doi:10.1056/NEJM200001203420312. PMID 10639550.
  • Infographic by SteadyHealth.com
  • Infographic by SteadyHealth.com

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