Girlfriend wants to help her dad die

[Anonymous666]

So my girlfriend's dad is a 74 year old with newly diagnosed louis body dementia. He's had a few cardiac stents in the past, A-fib at one time, and a traumatic SDH from a fall while taking xeralto.

He deteriorated pretty quickly over the last couple of years. From living by his self and walking/bicycling to the store and back to falling at home and having moments of confusion.

He was first dx'd with parkinson's, and has just been given the louis body dx by a new neurologist.

Sinemet has been really helping him to where if he misses a few doses, he's in a wheelchair.

Currently he lives in a memory center. He is confused. He is incontinent. He walks with a walker and feeds himself. We visited him the other day, and he knew who we were. A few days later, my girlfriend went to visit him and he didn't recognize her (this was the first time for this. It killed her, and she said then she has lost dad). He paces at the facility all day and has the delusion that everyone there is "gay." He worries that he is gay. He thinks he's at a hotel sometimes. Other times, he thinks he is at a restaurant. We recently flew him from Houston to Florida (to be near us), and he still asks when we are leaving to go to florida.

Anyway, my gf is his medical POA. He has a DNR and detailed living will. My girlfriend wants to stop all his medications and have him admitted to hospice care so he can be made comfortable and die naturally, rather than continue to increase his sinemet dose and keep him alive in this state for another decade or two.

Dose anyone have any advice on how this would possible?

His primary is all for this plan. His neurologist's NP, who hasn't seen him, mentioned a court order would be needed for her to stop his meds.

We have a hospice eval coming out to see him. However, I don't think he'll qualify given his current state. If she stops his meds, he'll basically be bed-ridden and will no longer be able to eat (he specifically states in his living will that he does not want tube feeding).

We are thinking if he doesn't qualify for hospice, bring him home, stop his meds, then have hospice come out for another eval once he deteriorates more. But we're worried the state will see this as abuse.

This is so frustrating. I know euthanasia is not legal, but stopping life-prolonging interventions for a patient is.

Any advice would be much appreciated.

Thanks in advance

[caliotter3]

I don't think I would be able to stop meds if I thought they played any part in increasing someone's comfort level. I think he could just remain where he is and let nature take its course with others providing for his daily care. Unless family members are prepared to provide all care at home, that would be the easier choice. What if the family takes him home, stops all meds, and then he lingers? The family must also prepare for that possibility. Seek support from friends and family in this most troubling decision making process.

[Nascar nurse, ASN, RN]

I'm not convinced that failure to give Sinemet is going to cause him to die - but very likely to cause his quality of life to be miserable. Maybe he'll eventually die once he progresses to the inability to eat but that's not going to happen overnight.

I've been a hospice nurse, I'm a huge supporter of end of life care - the whole quality of life vs quantity argument, but I don't know...my initial thought is a slow cruel way to die. Do some further careful research before making these decisions.

[Anonymous666]

Thanks for the responses, guys!

He was admittied to a home hospice company today. They stopped all his meds like xeralto, Lipitor, and even exelon but left him on the sinemet for now. Apparently, they left him the sinemet until the doc comes to see him.

My girlfriend's wish is for them to stop all meds. I understand the quality of life argument for keeping him on it. However, we're looking at it as something that prolongs him existing in a mentally tortured acid trip. We want to stop this for him. He watched his mother go through this and specifically told my gf to not ever let him end up like this.

I guess my real question is can hospice force the sinemet on him or is my gf capable of stating his and her wishes and requesting they stop it and just treat his anxiety/pain, etc with prn meds?

[CoffeeRTC, BSN, RN]

I would suggest a hospice consult. Why would his Sinemet need to be dc'd to be on hospice? I would think it would provide comfort and a better quality of life with the med.

[caliotter3]

You need to discuss hospice policies with the hospice company.

[Anonymous666]

I would suggest a hospice consult. Why would his Sinemet need to be dc'd to be on hospice? I would think it would provide comfort and a better quality of life with the med.

Like I said above, the sinemet is extending the time he has to suffer in this paranoid and confused world and is only delaying the inevitable-not being able to feed himself and/or becoming too confused to be fed. This is his (and I think most people's worst nightmare), why would prolonging it be providing someone a better quality of life? I can see that there is an argument for the contrary. However, shouldn't this be about the pt's and family's wishes?

The plan is for him to die in peace, rather than keep him alive in this state and instead just slow down and extend the degeneration and deterioration of a loved one.

Our worry is that hospice will not allow this and will force him to keep taking it.

We are looking at the sinemet in the same way one might look at tube feeding.

[traumaRUs, MSN, APRN]

So very sorry for this situation. Best advice was offered above: talk to the hospice nurses.