Sarah’s Second Attempt to Stop Eating and Drinking: Success at Last

Sarah was an 81–year–old widow who had been living independently for seven years when she pushed her life–line button for the last time. This was the second time she had fallen that morning and had to call for help because she could not get up. The first time the EMTs arrived, they helped her up and into a chair and left. The second time however, despite her strong objections, they transported her to the local hospital where it soon became apparent that she had suffered a serious stroke. Her daughter Laura rushed to her bedside, and as Laura waited to speak with the neurologist, she reviewed in her own mind her mother’s medical experiences.

Sarah had been a life–long member of a “right to die” organization, and was adamant that she would never agree to be in a nursing home. Her husband had died of Alzheimer’s disease the previous year after spending the last five years of his life in a nursing home as his dementia progressed. Sarah found the nursing home atmosphere so awful that she visited infrequently. She lived a life of happy independence in her sunny apartment with its prominently displayed grand piano that she played each day with great passion and skill. She had friends in the neighborhood, played Mahjong regularly, and kept in touch with other friends and family members by e–mail. She loved to read, listened to music all the time, and was very aware of current events as she read a daily newspaper on her computer.

But things had begun to deteriorate over the past year. Laura counted up the number of falls that required hospitalization and treatment for broken bones. Sarah had broken both shoulders and several ribs that left her with diminished upper body strength. She was impatient with the recommended physical therapy and often stopped too soon—with the result that she could no longer get up from the floor when she fell—accidents that now happened regularly. When Laura met with her mother’s physicians, they confirmed that she had experienced a stroke that left her paralyzed on the right side of her body—her dominant side—although she appeared cognitively unaffected. The doctors also thought that she had suffered a series of ‘mini strokes’ in the past—hence all those falls.

Sarah remained in the hospital for a week before being transferred to a well–regarded rehabilitation facility in the area. Laura visited every day and was initially pleased to see that her mother willingly participated in the rigorous physical therapy—three times a day and twice on Saturdays. While not much could be done with the muscles on her injured right side, she clearly was developing muscle strength on her non–affected left side—strength that would be necessary if she was to successfully ‘transfer’ from bed to wheelchair. The rehab clinicians anticipated that Sarah would be with them for three months and then ‘transition’ to an ‘extended care’ facility. However, that was not to be

Despite the excellence of the care, Sarah found it intolerable that she needed assistance with all aspects of daily living. She had always been a private person, and to have to ask (and often wait) for assistance with toileting and personal care became increasingly humiliating and frustrating for her. Each day she would tell Laura that she “wanted out of rehab and out of life´ and she wanted her daughter to help. Laura was not surprised by her mother’s request that she help her to die “on her own terms.” Sarah lived her whole life on her own terms and spoke often of her belief that she had the ‘right’ to decide when “enough was enough.” Understandably, Laura felt conflicted. She had been raised to believe in the right to self–determination regarding the end of life, and yet she didn’t want her mother to die—or at least, not yet. She conferred with her brother, her husband, and her sister–in–law who was a nurse. She also contacted the Clinical Coordinator of...