When is it Okay to Choose Death?

Disclaimer: the contents of this hub do not reflect any one religious belief, textbook, or philosophy. They are merely the observations of the author.

"What do you want me to do if she goes into cardiac arrest tonight?" the doctor queried. My husband and I looked at each other. Although we were at the hospital there with his mother, we did not have the authority to make that kind of decision.

My husband called his father, and without hesitation, he said, "Resuscitate!" His response surprised us. Just the previous day, the talk was that it was time to let mother go. She had been in critical condition in the intensive care unit for nearly a week and each day brought further indications that her time was short.

As more organs malfunctioned, the doctors proposed the possibility of exploratory surgery. They gave the family three options, and the decision needed to be made in less than an hour:

  1. Do the surgery immediately, however; the chance of survival was a mere 10%
  2. Continue the current treatment protocol, which was evidently not working, and would only prolong her agony
  3. End the treatment, and in so doing, hasten her final moments

The family was summoned via telephone, and the realization of her impending death was acknowledged by all. No matter what we did, mother's life was coming to an end. How could we make such a decision?

Those from out of state pleaded for treatment to continue, that her life might be spared until all were gathered. They began the long trek across state borders, hoping that they would get to see their mother one last time.

From birth to death, life hangs in a delicate balance. Only God knows the end from the beginning, and when we will be called home.
From birth to death, life hangs in a delicate balance. Only God knows the end from the beginning, and when we will be called home. | Source

What is death?

In order to understand the nature of death, we first need to understand where life comes from. Upon conception, cells begin to form and grow, gradually becoming skin, bones, nerves, blood, and organs. Each cell is dependent upon the life-giving substance provided by the mother.

We do not know at what point spirit and body unite to form a living soul. Some believe it is at conception, others at birth. We do know that once the infant leaves the mother's body, it must depend upon its own vital organs for life to continue. Should something happen to one of these organs, life for the infant may be jeopardized.

"...the spirits of all men, as soon as they are departed from this mortal body, yea, the spirits of all men...are taken home to that God who gave them life."

Alma 40:11*

Death occurs when the organs cease to provide their life giving substance.This does not necessarily happen simultaneously. It may be sudden, as in the case of an accident that damages organs to the point of being unable to function. The brain may continue to send out signals, but if the organs are unable to respond, death is accelerated.

Death may occur gradually, over the course of months, or maybe even years. Chronic disease sets in and vital organ function may need to be supplemented by dialysis, a pace-maker, or continued administration of oxygen. In any case, death is not pronounced until the heart ceases beating and the body heaves its last breath.

At that point, the body lets go of the fluids retained in the systems, as well as the waste being processed in the intestines. The eyes and mouth fall open, and brain activity comes to a halt. Stiffness eventually signals the absence of life.

In order for the body to survive, the organs must function independently of outside influences. Otherwise, death is at the door.
In order for the body to survive, the organs must function independently of outside influences. Otherwise, death is at the door. | Source

How can we know when a person is dying?

Only medical personnel are qualified to determine whether a person is alive or dead. We cannot make that determination. There are signs however; red flags, that give us warning that death is on the horizon. We would do well to heed these warnings, and make end of life preparations.

1) the onset of degenerative disease - chronic illness in and of itself can happen to anyone, and through proper management, a person can live a long time. Degenerative disease is different, it means that the body deteriorates over time, with the condition worsening to the point that death is imminent.

2) additional diagnoses - as the body continues to weaken, additional issues arise, and diagnoses are added, each one another signal that time is short.

3) snowballing affect on organs - when one organ ceases to function, another is dramatically affected, then another, until finally, the body stops all vital functioning and death occurs.

4) lack of consciousness - as the organs cease their functioning, the lack of nutrients in the brain leave it unable to process sensory information. The person goes unconscious, as if in a deep sleep. There may be movement, even response to stimuli, but until nutrients are provided in an ongoing basis, the brain will not fully "wake up." A continued state of unconsciousness, coupled with organ malfunction, indicates that death is near.

5) frustration on the part of physicians in lack of response to treatment - once the body is on a downward spiral toward death, treatments that may work toward healing in other circumstances receive very little or no response. When the body is unable to reverse the trend of disease and dysfunction, death is not far away.

When the body must depend upon outside sources for nutrients and vital body functions, drastic action must be taken.
When the body must depend upon outside sources for nutrients and vital body functions, drastic action must be taken. | Source

What is the role of the Advanced Medical Directive?

The Advanced Medical or Health Care Directive (AHCD) is designed for just these circumstances. It must be considered, discussed with loved ones, and signed when a person is in a positive frame of mind and able to make logical choices based on desired outcomes.

Waiting until one is already in a hospital bed is too late. Then emotion takes over, and people do what they feel is best, not what is logical and practical. Family members may also disagree on what is to be done, depending on the outcome that they desire, not what is best for the patient.

There are several questions that are answered with this type of document:

  • Who is responsible should the person become incapacitated and unable to determine their own course of treatment?
  • Under what conditions is the choice made to terminate treatment?
  • What provisions will be made to keep the person comfortable until death occurs?

The AHCD allows a person to die with dignity. It outlines the definitions of a terminal condition, life sustaining treatment, and a permanent unconscious condition. It gives the family the right to refuse treatment that would only prolong the suffering of the person in their dying condition. It gives them the ability to determine to a large extent when and how their family member experiences death.

The AHCD is different from a Do Not Resuscitate, or DNR order. Only a doctor can put a DNR order in a patient's chart. Most physicians will ask the family what their desires are, if the patient is in a state where they could expire at any moment. Once the DNR order is put in the patient file, some type of signal is put on the patient's person, such as a colored wrist band, that indicates that they be allowed to die without interference.

We never know when and how our last days, hours, and minutes will be. Having a plan in place alleviates many fears.
We never know when and how our last days, hours, and minutes will be. Having a plan in place alleviates many fears. | Source

When it is okay to choose death

The irreversible finality of death gives it a negative connotation. We are taught all throughout our lives that choosing life is the way to go. We shun death, even avoid talking about it, and do everything we can to keep ourselves far away from it.

Those who actively cause their own death are considered to have some type of mental illness or distorted thought processes. Those who take the life of another are tried in court for breaking the law. And yet, there comes a time in our lives when death is inevitable. We all die, there is no getting around it.

In the case of my daughter and her family, illness struck one of their own at a young age. She gradually lost her abilities to the point that hospitalization was necessary. When her state became one of unconsciousness, with no hope of recovery, they had to decide what to do.

Should life support continue in a nursing home situation, or is it time to disconnect and let her pass? The family gathered in the room with their precious loved one as the doctor's disconnected the equipment, and watched her peacefully drift away. Tears and prayers were offered in her behalf.

In the case of my beloved mother-in-law, as her failing condition become more evident and the family was called together, medical support was not enough to keep her going. Her body let go before all could gather. Although she was surrounded by loved ones when her spirit left this world, there were some who did not make it. We never know when it will be our time to go.

Prepare now for your final moments, for your emotional health!

© 2014 by Denise W. Anderson. All rights reserved.

*The Book of Mormon, published by The Church of Jesus Christ of Latter-day Saints. Follow link to on-line version.

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24 comments

mbwalz profile image

mbwalz 2 years ago from Maine

I am sorry that our culture does almost everything to avoid death, but forgets that life without dignity or hope is not life. Many claim that God wants the person to live and we shouldn't interfere. But that time has usually long passed. We should change how we look at death. God or whatever did not create an end for nothing. And if you do believe in God, for goodness sakes, let the person go as God is obviously calling them.


MsDora profile image

MsDora 2 years ago from The Caribbean

This could be confusing subject, but you made good sense of it. Death is certain, and your appeal to plan ahead is wise and timely. Your article is very useful in helping us deal with it. Voted Up!


Mel Carriere profile image

Mel Carriere 2 years ago from San Diego California

I don't think there are any absolute correct answers here. Hopefully we will all be mature enough to prepare this in advance and spare our loved ones the agony of making this decision. Great hub!


denise.w.anderson profile image

denise.w.anderson 2 years ago from Bismarck, North Dakota Author

That is a good point, mbwalz. My hope in writing this article is that we can discuss these things before they happen, and have some kind of dialogue with our loved ones while we are in our kitchens and living rooms, rather than waiting to address these issues when we standing in front of a doctor, and have only an hour to make a decision. I believe that God hears and knows our pleas, and that in his infinite patience, he allows us to experience the consequences of our actions in this matter.


denise.w.anderson profile image

denise.w.anderson 2 years ago from Bismarck, North Dakota Author

It is a very confusing subject, MsDora, that is why it is so touchy ethically, and emotionally. We do not pretend to be God, knowing the beginning from the end, and we, sometimes hopelessly and helplessly, expect the decision to be made for us. When it comes time to be confronted with these issues, it is too late to gather information and think in terms of logic and practicality, or even what is right or wrong. Thanks for the up vote and your words of encouragement!


denise.w.anderson profile image

denise.w.anderson 2 years ago from Bismarck, North Dakota Author

There are not any absolutely correct answers here, Mel Carriere. We each have to consider our own beliefs, what we are comfortable with, and the desires of our loved ones. When death is imminent, time is not on our side, and our advance preparation is what will carry us through. In this time of intense emotion, we cannot rely upon our own senses, or even our spiritual awareness, to give us solid answers. Thanks for the comment!


midget38 profile image

midget38 2 years ago from Singapore

It's always, always hard to decide and it's being caught between a rock and a hard place.


denise.w.anderson profile image

denise.w.anderson 2 years ago from Bismarck, North Dakota Author

Yes, end of life decisions are the hardest we will ever make! There is no convenient time to talk about these matters, but it is a must to address them ahead of time. Thanks for reading and commenting!


lisavanvorst profile image

lisavanvorst 2 years ago from New Jersey

I have worked in long term care nursing homes and most resident have an Advance Directive with health care proxy and most who are elderly have a DNR. These are tough decisions, but while the elderly person is alert and oriented and able to make these decisions, I encourage family members to talk with their mother, father, aun't, uncle etc. I really feel the person is easing the pain by drawing up these documents. When left to the family it is often confusing, difficult, geared by emotions and also can cause family arguments that are known to tear families apart. No one wants to discuss death, but even those in their forties and fifties should consider an Advance Directive. Very informative hub.


denise.w.anderson profile image

denise.w.anderson 2 years ago from Bismarck, North Dakota Author

Thanks for sharing your experiences, lisavanvorst. We never know when the time will come that we may be in this predicament. I know of people who have been in accidents that end up in long-term care situations while still in their prime. Talking about these things gives us the opportunity to discuss the ramifications of the various scenarios, as well as our own philosophies. It is surprising how different family members view things, even though they may be the same religion and/or political preference. Each person has to make their own beliefs and wishes known, and put it in writing for others to see.


Sherry Hewins profile image

Sherry Hewins 2 years ago from Sierra Foothills, CA

I think that withdrawing life support or aggressive treatment is a much different thing than active euthanasia. It gets to the point that life is being artificially sustained way past when there is any hope for recovery.


New Newbie 2 years ago

This is a very important issue, and something too easy to put off dealing with.

At some point the technology used to extend life, is only prolonging death. I've personally witnessed loved ones choosing to prolong the dying process because the patient had not expressed what their choice would be. The loved ones would have very much appreciated not having to face this dilemma.


The Stages Of ME profile image

The Stages Of ME 2 years ago

Denise

First so sorry for your loss, but second congratulations on a beautiful and well thought out hub. Death is a difficult topic when not visited early on by family members. The reminder to have conversations when well is a wonderful and beautiful reminder. It is much harder when the emotion of the moment is at hand. It is important to have all the information so an informed decision can be made. There is great peace in the person having a say in their care, but when not possible it is so wonderful when the family can agree on pallative care and dignity to the person experiencing a physical death, for the soul continues. Blessings


denise.w.anderson profile image

denise.w.anderson 2 years ago from Bismarck, North Dakota Author

You are correct, Sherry, active euthanasia is the hastening of death prematurely, whereas withdrawing life support simply means that death will take its natural course. Thankfully, we live in a conservative area, and the doctors were able to give us an honest diagnosis that death was imminent, and the family was able to see it. It would have been much more difficult had that not been the case.


denise.w.anderson profile image

denise.w.anderson 2 years ago from Bismarck, North Dakota Author

That must have been difficult, New Newbie. When we do not know what to do, our natural instinct is to prolong life as long as possible. We do not want to be the one that say it is time for them to go. We depend on God to do that for us, but sometimes, we have to make a choice as to when it will actually happen. Thanks for reading and commenting.


denise.w.anderson profile image

denise.w.anderson 2 years ago from Bismarck, North Dakota Author

Thank you for your expression of sympathy, Stages. I have learned much through this experience that I am sure will come in handy in the future. We still have three living parents! We have been trying to have these conversations with them, but my mother simply says, "I am not going to die!" She won't even go there! Thankfully, Dad has been more open about it. We first address the issue of where they would like to be buried, then try to approach the "what if" scenarios that would lead to legal documents being created. So far, my husband and I are the only ones who have them!


brutishspoon profile image

brutishspoon 2 years ago from Darlington, England

I can remember when my Dad found out he had Stage 4 Lung Cancer. He did not like the prospect of having to have an oxygen tank to help him breath. He had been through hell in his early adulthood while in the army and survived major injury and did not want people to see him as weak. He pulled me to one side away from my Mam and asked me to help him if it got to that point. I knew what he meant and although it is not legal I was willing to do it if necessary. It never came to that and the Cancer which was wrapped around his main artery in his lung did its job. My mam asked me to try and revive him as I was a first aider but I knew he did not want that and although I did try it was more for show and I let him go. It was hard but even if I had tried harder it would not have worked.

My mam is from a Catholic family and I think that is partially why my dad did not want to confide in her.


denise.w.anderson profile image

denise.w.anderson 2 years ago from Bismarck, North Dakota Author

Thanks for sharing that difficult experience, brutishspoon. Religious beliefs sometimes inhibit our ability to allow others to make a choice in end of life situations. You must live with some difficult feelings as a result of being caught in the middle. Fortunately, the Health Care Directive that is available now can give a person direction in these situations. We can legally withdraw treatment, or even refuse it, if that is what our loved ones wish.


brutishspoon profile image

brutishspoon 2 years ago from Darlington, England

My dad was just about to sign a DNR when he died. As it was never signed the paramedics that came when my mam rang them had to try to revive him. I felt bad because I did not want him to go but knew he wanted to die.


denise.w.anderson profile image

denise.w.anderson 2 years ago from Bismarck, North Dakota Author

It is tough to see someone in that situation, when they know it is time, but at the same time, you know you will miss them when they are gone.


midget38 profile image

midget38 2 years ago from Singapore

Denise, this was a frank and brave share. I believe that this is a difficult, age-old question that we'll always struggle to address.


denise.w.anderson profile image

denise.w.anderson 2 years ago from Bismarck, North Dakota Author

Yes, midget38, the advertising was removed after it was published! I guess it is brave, but it is a question that needs to be addressed. We have had to look at our own situation with the eye of an eagle in an effort to answer it ourselves. With a daughter having disabilities living with us, we felt we needed to have some options in place. The question is whether we want to struggle to answer the question while we are in our right mind and emotionally stable, or wait until someone is on their deathbed and we have to decide when to pull the plug!


TIMETRAVELER2 profile image

TIMETRAVELER2 2 years ago

When all hope is lost, it is time to let go. Prolonging death makes the sick person suffer even more, when death would bring relief. Ending life is difficult, but in many cases, it is the right decision. Great article. Voted up.


denise.w.anderson profile image

denise.w.anderson 2 years ago from Bismarck, North Dakota Author

You are right TimeTraveler. In my mother-in-law's case, we were fortunate to have the doctor tell us it was time. In my grand-daughter's case, my daughter and her husband had to make the difficult decision. They sought our advice as relatives, and we had a long talk about the ramifications. When they finally made the decision, they were able to feel peace.

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