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Totally agree.my mom was being killed by hospice,we we asked was she in any pain , we asked mom ,she said no, hospice nurse showed up requested by doctor,they start mom on morhine ,eery 4 hours, we would come to visit .breakfast tray ,not touched ,she was not woke up to eat,we asked when will she be awake.no drink no food,so I asked why you killing my mom,they respond ,he s dying not eating first symptom,day,I asked what is her meds ,for pain morphine every 4 hours, ,I as son, said I do not agree, you are not treating my mom,they said if I want her alive send her back to the hospital,mom was dehydrated, lived January 25to October 2 , that year, talking eating pudding ,drinking milk shake ,10 months ,after,hospice was fired,so what is your opinion, they were shortening her life and killing her, but end result was nursing home neglect, and saying mom was diagnosed with c- dif, multi anti biotic poisoning , was rushed to hospital which she returned from only a week before,when was taken in hospital was given multiple antibiotics ,caused her heart to race over 200beats ,then they shoed to slow her heart ,and she died, strange thing was we were told she died 4:pm, we were then told she died 7pm,,4000.00 For autopsy,we could not afford, Why ,why,why family suffers at hands of nursing and doctors ,and their is nothing to o about it,any answers?
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Totally agree.my mom was being killed by hospice,we we asked was she in any pain , we asked mom ,she said no, hospice nurse showed up requested by doctor,they start mom on morhine ,eery 4 hours, we would come to visit .breakfast tray ,not touched ,she was not woke up to eat,we asked when will she be awake.no drink no food,so I asked why you killing my mom,they respond ,he s dying not eating first symptom,day,I asked what is her meds ,for pain morphine every 4 hours, ,I as son, said I do not agree, you are not treating my mom,they said if I want her alive send her back to the hospital,mom was dehydrated, lived January 25to October 2 , that year, talking eating pudding ,drinking milk shake ,10 months ,after,hospice was fired,so what is your opinion, they were shortening her life and killing her, but end result was nursing home neglect, and saying mom was diagnosed with c- dif, multi anti biotic poisoning , was rushed to hospital which she returned from only a week before,when was taken in hospital was given multiple antibiotics ,caused her heart to race over 200beats ,then they shoed to slow her heart ,and she died, strange thing was we were told she died 4:pm, we were then told she died 7pm,,4000.00 For autopsy,we could not afford, Why ,why,why family suffers at hands of nursing and doctors ,and their is nothing to o about it,any answers?
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Totally agree.my mom was being killed by hospice,we we asked was she in any pain , we asked mom ,she said no, hospice nurse showed up requested by doctor,they start mom on morhine ,eery 4 hours, we would come to visit .breakfast tray ,not touched ,she was not woke up to eat,we asked when will she be awake.no drink no food,so I asked why you killing my mom,they respond ,he s dying not eating first symptom,day,I asked what is her meds ,for pain morphine every 4 hours, ,I as son, said I do not agree, you are not treating my mom,they said if I want her alive send her back to the hospital,mom was dehydrated, lived January 25to October 2 , that year, talking eating pudding ,drinking milk shake ,10 months ,after,hospice was fired,so what is your opinion, they were shortening her life and killing her, but end result was nursing home neglect, and saying mom was diagnosed with c- dif, multi anti biotic poisoning , was rushed to hospital which she returned from only a week before,when was taken in hospital was given multiple antibiotics ,caused her heart to race over 200beats ,then they shoed to slow her heart ,and she died, strange thing was we were told she died 4:pm, we were then told she died 7pm,,4000.00 For autopsy,we could not afford, Why ,why,why family suffers at hands of nursing and doctors ,and their is nothing to o about it,any answers?
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Papscal so glad to read your comments about the true nature of hopsice. I would just add that a patient can be admitted to hospital for various reasons at the ned of life and need not be discharged from hospice. However life saving measures will not be given as long as a vald DNR is available. Bowel management is still important because it can cause great discomfort. After a manual examination is performed an enema can be given. Removal of excess of excess from the body may be accomplished by the use of diuretics or other means but like every other marvel of modern medicine at the very end nothing slows the dying process and the on treatment is directed at comfort and this includes comfort for the family as well. Becoming a hospice worker takes a great deal of knowledge and commitment. this applies to the entire team not just the nurses that you have most frequent contact with. Everyone has their own needs and demands so some people will always hold different views of the care recieved. The goal of hospice is neither to prolong life nor end it faster. No one is forced to use their services.
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@scarlita65

Sorry for your loss and horrible hospice. I would have gotten her the meds for pain and discomfort ASAP. I dispise nurses who wont medicate. All the signs and symptoms of discomfort I look for you explained.
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@cassestar

Best wishes.

Hospice is intended for end of life care and should also help loved ones cope with the loss. Hospice is often initiated by the Attending Physician by sending a consult to a hospice organization to see if they meet criteria and the family to should be involved in this decision.

Service are generally revoked when a loved one is taken to the hospital because it is considered an attempt to save or prolong their life when their diagnosis is such that they may be terminal and at the end of thier life. It often indicates that the individual and loved ones are not ready for the inevidable which possibly wasnt explained to you.

Not knowing his exact condition makes answering some of your questions difficult but for him to be admitted to Hospice his prognosis isnt or wasnt good. Lasix doesnt reduce fluids in the lungs it helps with generalised edema and blood pressure. In the end stages of dieing people tend to drink and eat less if at all. They make liquid stool softners but having a stool is the least of his worries. We often put in catheters so we can monitor urinary output. again not knowing specifics makes it hard to answer.
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From a son who lost his mother to Ovarian cancer to becoming a hospice nurse.

Let me start by saying Hospice is a phenominal thing speaking as a patient and a Hospice nurse. Thank whoever you believe in for the narcotics and other medications for symptom management and a nurse who knows how to recognize these signs and symptoms and administers responsibly. So that loved ones dont cry out in pain, have the look of dicomfort, difficulty breathing because body system are shutting down and their lungs are filling up with fluid For there has been numerous studies and tons of evidence proving that these drugs do not cause death in the already dieing patient as the body metabolizes these drugs differently than a healthy person.

How selfish is it to want that last word and keep your loved one awake in a suffering state so that they can afirm your feelings of love. The thing with hospice is that many people really truely dont understand what it is all about. When I got this opportunity to be a Hospice nurse I was truely blessed to be able to affect so many lives. I can make a negative situation positive. You are supposed to treat the family aswell as the person latying in the bed.

I am sorry for those who had bad experiences with hospice because it was the failure of that nurse and social worker to explain and educate on the dying process. Death happens so differently for everyone no one death has been the same for me. I have had people how have taken upwards of 120mg of morphine an hour for days at a time, for the lay person that is a heck of alot and would kill me a healthy person. There are others who took 10mg an hour and lasted hours, so they are all different.

The fact is we love our people and want them arround for ever. We need to be realistic and not be selfish and make sure our loved ones pass in peace.
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I am seeking answers to the same question - what is the purpose of hospice and how is the timing of the 'service' managed? We are not professionals and hospice was called not to help my partner 'die peacefully without pain and relieve his anxiety' (from a year of insomnia), but actually to deactivate a pacemaker which was not really used, even though his diagnosis was/is heart disease. A huge misunderstanding. Only an electrical outage in a huge storm forced us to revoke hospice on the fourth day of morphine/ativan. His breathing got slower and slower and he needed oxygen. We called the fire department for a generator and they could only take him to hospital, since the oxygen machine could not work without electricity! The storm saved his life! I highly question this service, not its goals whe totally appropriate(?) but its shortcomings, especially the lack of concern/steps to provide practical 'life support', i.e., hydration, help with urination (or sure kidney failure) for example. And what about stopping vital medicines like lasix which results in build up of fluids in the lungs? And severe constipation, since how can a drooling person with a closed mouth take a stool softener pill? Someone please shed light on this issue. Casse in California
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@Dogabone ... you're the one who is clueless. I've seen it happen several times. Rosie123 has it right ... and it needs to stop.
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I have experienced this as well, having an alert father, who passed just a few days after being admitted to hospice. However, I am a hospice nurse. I fully realized that his disease process had reached a point where the disease was going to take his life, not the medications used by hospice. I could only work to ensure his comfort. It was a comfortable death, despite his widespread cancer!
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@2smart...oh yeah, that's exactly what can happen. Right now this hospice team is in shock because she's better than she was. For me hospice is for when you no longer want procedures or can't tolerate them and want to stay home. She can deal with a certain amount of pain, but I never let it get too bad...I also refuse to drug her to the hilt because her liver can't take it. Constantly monertring her because I can't go by the clock on what she can tolerate. I'm prepared for her to be with us a day, or a week, a month or a year, but it won't be because she's over medicated, that's for damn sure. Lol, I take you wishing I was your SIL as a compliment! Anyone out there considering hospice, it can and should be done on their terms, what the family and the loved one WANT, not the way they want. Don't be bullied, not take their word as gospel, they are only human, a degree and a badge do not make them GOD, if you see something you're uncomfortable with say NO. Those who've already lost a loved one, you didn't do anything wrong, they did by lack of compassion, not walking you through it and making you feel as if you had no say...ultimately they are employees of your loved one, their insurance pays them. They are so wrong by leaving you feeling this way.
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Hansolo, I wish you were my SIL! Through this forum and in personal life, I am hearing more and more stories that parallel mine. My husband's ex was put on hospice care a couple of days before Christmas...my stepsons took pictures of her sitting up, talking, interactive. She doesn't look healthy in the pictures (drinker, smoker) but not terminal. Not even particularly sick. They signed the hospice papers, consented to morphine, went out for a bite, and returned two hours later to find she had passed. It's just too shocking.
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If I feel they won't, I will call an ambulance. I do get what you mean though....I've had to fight for certain medications because they are very expensive, I went around them and went straight to Medicare. It's ONLY because I've been through this before with grandparents and I'm not in a state of shock and SIL is younger and stable for the moment I know how to deal with them....they can't bully me. With my grandfather on hospice I saw what you experanced...morphine morphine morphine...Ativan Ativan ativan... I'm catholic and was very uncomfortable with the situation, but I was not the decision maker, my dad and my aunt were. We talked about it (well, dad & aunt did) and they felt it was appropriate. After that experance, I stopped giving a shit WHAT medical staff advised for end of life and fought for what I deemed appropriate. As my dad was passing I told a doc in no uncertain terms I would insist my dad be fed. I took him off vent, I signed a DNR, but that was my line. Personal choice, not advocating that for anyone else or saying anyone is wrong for deciding not to continue nutrition, but I had decided food and water were never to be withheld with my dad. I was in your shoes with my grandpa, so I know EXACTLY what you're talking about. You, on the other hand, DID NOT ASIST THEM. they were supposed to respect your wishes and give comfort and them being professionals, you trusted them. They can bully you into doing what they think is right, where it may not have been the right thing for your state of mind....hold on to the fact your mom passed pain free and you did the absolute best you could. They should have given you the choice and walked you through every step and every process. That particular team was very wrong in leaving you feeling this way. Even on this team one individual on the case was all about 'drug her up so she's comfortable' and I told her those meds in those doses would take her out in 3 days. One individual does not mean all of hospice is like that at all, most are caring and compassionate, some should not be in that field of medicine at all. Sadly, I've been through this enough times with both sets of grandparents and dad and my sister that I've seen the most beautiful dignified passing of my grandma on hospice and the bad experance with grandpa. It is still preferable than in the hospital when there is no hope of recovery....my other grandma and sister and MIL all went in ICU in horrible pain and awfulness even grandpas passing at home that way was absolutely preferable
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There are so many variations in how hospice is implemented. The hospice service we used would NOT give my mom IV fluids and that is the core of my conviction that they were on a mission to end her life as quickly as possible. Before I signed the papers, the hospice representative gave a non-committal answer when I asked if she could have them, but when I wanted them to give them to her they wouldn't and I was told I must not be clear on what hospice is". They just wanted to poison her to death with Ativan and morphine (and yes, I believe this is a form of murder...but I signed the papers so that makes me an accomplice, doesn't it?) So Hansolo, your SIL is incredibly fortunate to have you caring for her but you may find when the time comes that those IV fluids might get withheld after all. We were promised all kinds of things to get us to agree to hospice, but the only thing that was delivered was Ativan and morphine.
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Oh noooo she's not in a coma at all. She's awake, alert, walking, eating think it's prolonging her life because she is no longer receiving invasive procedures at the hospital, which her body can no longer tolerate due to her condition. Since her last procedure for a brain hemotoma, she isn't herself really, big personality changes...but slowly I see glimpses of HER. At home hospice will still give antibiotics and/or Iv fluids for dehydration should it come to that point. Other than that, she does not want to be hospitalised, no invasive procedures so for her this is giving her a certain quality of life without being poked and prodded when nothing can really be done to 'save' her at this point
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To hansolos - I have a question, because I'm not sure what you meant when you said, "I honestly think hospice is prolonging her life & for the better. " It sounds like she is in a coma. Please explain why prolonging a coma would be for the better. Or did I mis-read something? It just didn't make sense to me. Is it better for her, or better for you that her life is being prolonged? I don't get it. ?
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When the family and patient are not informed, it's murder, not negligent homicide, and this should not happen ever. My reference was to point out the reality that morphine and medications are routinely used in hospitals, in care facilities of all sorts, and in the home, to hasten death and that it's more common than most people think it is. And that some people appreciate that this happens, whether it's legal or not. Not at all questioning the morality of the underlying issue, as it says.
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I just want to comment on this: "Whether you believe in the morality of assisted suicide for terminally ill patients or not, it is and has been a reality for a long time,"

I DO believe in assisted suicide, and I think it should be discussed and legalized in the US and abroad. BUT, what we currently have is SECRETLY assisted suicide, which is abhorrent to me. The patient and family MUST be involved. This is the problem. Until we talk about the fact that it should be an option, and until we involve the patients and family, it's not assisted suicide, it's negligent homicide.
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I currently have SIL on hospice. They ordered morphine, but we don't give it to her, just regular pain meds she's been on. She's in my home so I give the meds, nothing is pushed. I've been caring for her for 3 years. We absolutely do not want to speed anything up, but have the understanding she can go at any time. Because her liver, sometimes if she seems over medicated, I withhold meds awhile until she's alert, I watch her actions not the clock. If she's in pain I will give less strong meds sometimes instead of over medication. She's been on an anti psychotic because she's started having hallucinations, and it seems to help. She gets Ativan as needed, but not around the clock either. I do feel if I was to give her morphine and Ativan together on a schedule it could really make her pass quickly...reading this, I understand why some feel as they do. I've been giving her her medications so long and know her reactions so personally I don't worry about that part, but for some, if they read on label every 4 hours, you do it on the dot. THAT would be scary. We have her on hospice so she can get the care she needs without the fear of extraodernery measures as they did on dec 24 where for a Mri they had to put her under anaesthesia and vent where she became reliant. I honestly think hospice is prolonging her life & for the better. Liver disease is so tricky with medication so unless you are EXTREMELY knowledgable about how to administer meds, it is probably not a good option unless their passing is expected within days
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We had a wonderful experience with hospice-in-the-home care when my dad passed from cancer 20 years ago. I know things have changed since then, but have witnessed really good care in hospice facilities lately, too. Some are bad, some aren't. Regarding the initial post and the use of morphine, etc, to hasten death, yes, that is more common than you think, and no, we're not supposed to talk about it. Many people are very thankful that hospice can assist in this way. Whether you believe in the morality of assisted suicide for terminally ill patients or not, it is and has been a reality for a long time,
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Mel battled cancer for five years and won each time. After all clinical trials ran out she feared the worst, but used holistic and was doing better.

Doing what was best for her family, she quick claimed all she had to the husband and give spouse power of attorney. Spouse was to quick claim everything back to Mel, but would never sign the paper work. Spouse had been playing with her two best friends for five years.

One of the friends wanted to marry him and you can guess what happened next. First chance they got they placed her on hospice for a urinary track infection. Two days before Mel was placed on hospice she was at the beach, shopping, eating and having a great time. A few days later she came down with a urinary track infection. First day at home after hospice her personal things were being thrown out, no longer could she have money, credit card, or check book. Mel and I asked hospice if she wanted to see a doctor would it be allowed? Hospice said sure. Later hospice nurse screamed no you can’t see a doctor. (They even placed nannie cams in the room so when Mel wanted to change her power of attorney and see the doctor, (you guest it) they over dosed her and starved her). The parting started each week at home with 20 - 25 people and a crying baby, and load music. At time of death happy husband was screaming thank you God and I want her burned, burned, burned.

Husband is how having a great time with the new playmate and parting it up.

My daughter may have died but she didn’t need to be pushed. And girlfriend did say to Mel “why want you just die”. Spouse said after death he was done with her for over 6 months before she died. So why didn’t he walk out? Was it for the money? Plus at one point girlfriend ask hospice “why want she die”?. Hospice nurse “because her organs are just to strong. Was it cancer, or murder. I could talk on and on about the abuse I saw but you get the picture already.

Don’t trust hospice
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Kelly and Hillay, my sincere condolences. I lost my best friend in hospice on October 28, 2014. He was also on morphine and ativan. He had become setic and went into septic shock. Chances for recovery from that are slim. For the three weeks prior to hospice, the doc were throwing every treatment possible at him. Nothing worked. He was ready to go and had been struggling with his health for the past four or five years. He was tired of fighting and hospice helped him go peacefully.
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Kelly and Hillay, I'm so sorry for your recent losses and hope that time and grief work will help. I have not had direct experience with hospice, but my aunt, with chf, went on and off hospice over the course of several years, so not all experiences are the same. I'm so sorry that you feel you weren't given enough time with your loved one, but remember that sometimes, it's the patient's giving in to the process that hastens the end, because they are ready. Blessings to you both.
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Kelly, I am so very very sorry for what you and your mom went through, and for your loss. My experience with Hospice was very similar. My mom passed away on 11/11/14 and she was only 76 -- and I had been with her constantly, literally running around the SNF to get her proper care, then eventually calling in hospice to help. I also believe the medication given to her in the last few days brought her death prematurely. I know some hospice workers are great, but my feeling is that Ativan and Morphine are used to bring end of life - even if the patient is not ready for it. It may relieve suffering, but it should be up to the patient and the family to make that decision - not the doctors or hospice! It's just wrong and I want more people to know this before they allow hospice to administer drugs that bring on end of life prematurely. I think part of the problem is that the dosages are not understood for elderly patients, especially when they are so thin. But until they understand it, they should stop using it! The whole system is so messed up. It's completely confusing, even when you spend all of your time trying to figure out what is the best decision to make. And then, on top of it, we are emotional and stressed. I completely understand your feelings of guilt because I feel tremendous guilt too, but we need to try to forgive and heal. That is what our moms would want. I am looking into grief counseling, which I hope will give me some coping tools. Right now I'm still a mess.
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I love my Mother last November 24, 2014 and I have felt guilty every single day since that I allowed them to put her in Hospice care. It was my Mom's decision, she had been sick for 2 and a half years previously. She was in and out of hospitals, rehab centers and a nursing home. The Doctors called me in 4 times to make end of life decisions for her and each time I begged them to continue to do the best they could because my Mom was only 72. She came so close to coming home many times after rehab centers, she lost so much weight while she was sick, from 120lbs down to her lowest at 73 lbs, her muscles just didn't exist anymore but, rehab would build her back up and she'd put on some of the weight and feel great, she was clear headed and then would come down with another infection and we'd start all over again. But, the day she went to Hospice care, she was feisty, she had pneumonia and they wanted her to wear a B-pap (Not sure that's the correct spelling) to help clear her lungs but, she absolutely hated it, she felt claustrophobic and would fight the nurses even at her tiny petite size to keep it off her. Well that day she fought till she won, they didn't put the mask on her but, they were worried about her swallowing and she had an IV as well as a feeding tube that had been inserted early on because of her weight loss and trouble she was having so they wouldn't let her have a drink of water. That's all she wanted was a drink of water and next thing I knew she was telling me that she asked for Hospice and wanted to go. I was floored and didn't know how to respond. Next thing I knew Hospice was in her room and telling us all these wonderful things, that she would get all the things attached to her body off, she could eat or drink anything she wanted, they would not treat her anymore and basically just let the good Lord do what he needed with her. Mom told me if I didn't sign the papers, she would, I tried talking her out of it but she was determined. Then the Hospice person told me she could change her mind and that was fine they'd bring her back down to a room in the hospital and start treatments back up again. My mom said she promised she'd talk to me about it and we'd make more decisions together but, that I shouldn't feel bad, she said she was tired of all the procedures they put her through the past couple of years. So reluctantly and with a lot of tears I signed the papers and the lady from hospice sat there with her holding her hand, gave her a little morphine to relax her till they could move her. Next thing I knew they were moving her and as we got to her new room they told me to wait outside till they had her all fixed up and in bed. So I went out to make a couple of phone calls. Came back 15 mins later and my Mom was asleep. They said they gave her more morphine and ativan so I sat for endless hours waiting for her to wake up so we could have a long serious talk. Well, our last talk turned out to be when I signed the papers because she was never conscious again and passed a few days later. We didn't get to have some final talks, there was no food or water for her and some things I needed to know from her before something happened I didn't get a chance to ask. I will go to my grave feeling guilty that I didn't remain as persistent and I had been for two and half years that they do the best they could do for her. And funny thing, that kind, caring woman who promised her the world once she was in Hospice and holding her hand throughout, I never saw her again. I wish so badly I had looked at things like this online before I made that decision because I never would have done it because my Mom never got the chance to change her mind not to mention she never even got that drink of water she desperately wanted.
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surprise you are so right about Drs overestimating the time left for a patient to live. I think they see it as a failure of their expertize when a patient dies or elects to stop treatment.
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I just finished the new book, Being Mortal, by Atul Gawande. The first couple of chapters deal with nursing homes, and then the good stuff appears. He goes over the limitations of medicine, and how docs tend to overestimate how long a terminal person has to live. He does a great job of spelling out what questions to ask and what you should think about when pondering more treatment vs enjoying the time you have left. I was greatly encouraged by the book and encourage everyone to read it. It was available at my public library and even on their e-library lending service.
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Morphine is given for pain as are many other narcotics. They make the patient comfortable and as pain free as possible. Of course there are side effects as with most medications. Morphine is also given in very small doses to relieve the feeling of breathlessnes in such conditions as COPD and lung cancer.
Ativan is given for anxiety. It is not needed for every patient.
Loss of consciousness is frequent jn the last days of life and not necessarily drug induced. The alternative may be to watch a loved one screaming in pain and begging for help to die.
Many people and their loved ones wait till the patient is in their last days or hours to call in hospice therefor it seems as though hospice hastened their deaths because certain medications were used for them to be able to die in peace.
Sedation to keep a patient unaware of their last days which some people request is extremely difficult to get a Dr to order and has to be administered in a hospital setting where the patient is monitored on IVs. This is not part of the hospice philosophy. No medical professional can predict acurately the way a patient will die so preparing the relatives is not possible. They certainly can be told that the patient is probably approaching their last hours or days but every patient does not follow the "rules" The hope is always that it will be calm and peaceful and dedicated professionals do the best they can to make this happen. In the end the Lord takes the soul into His hands when he is ready.
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My husband did not have any morphine the five weeks he was on hospice care, because he was not in pain. His death was not hastened by drugs. The autopsy revealed severe dementia and also extreme hardening of the arteries -- the doctor commented he could not have lived much longer with that condition. He died when his body was ready. Hospice made it a little calmer for him and a little easier for me.
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Cancer may kill our loved ones, but Ativan and Morphine (and other similar drugs) brings on end of life / death. If we are all INFORMED of this, we will all be better prepared. Being prepared can't stop death, but when we are knowledgable about what is about to take place, and (more importantly) the timing of it, we can prepare ourselves and our loved ones, so we are all at peace. This is what needs to happen -- a more open discussion of what actually occurs at end of life, especially for cancer patients.
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