Caring for a person with dementia: end of life

At all stages in the course of dementia carers face the possibility of a time when the quality of life of the person for whom they are caring is so poor that they feel that for their loved ones to pass away would be preferable to continued deterioration.
One carer described the mixed feelings he experienced as his wife approached the end of her life and after her death. He felt that her total helplessness was degrading for her. He no longer felt able to make any contact with her, he worried about whether the nursing staff were making efforts to persuade her to eat and he felt guilty that he was able to go out and enjoy himself. Only some time after her death was he able to think of her with affection again, rather than with pain and guilt.

Felt guilty getting on with his life while his wife approached death.

Age at interview 78

Gender Male

Age at diagnosis 68

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In spite of the pain experienced by carers witnessing the progressive destruction of their loved one’s personality and the perceived indignity of the dependent existence they had been reduced to, there was almost complete consensus from carers that neither euthanasia or assisted suicide were appropriate.
For some people this was seen as a straightforward moral decision believing that the manner and time of death was a matter for God and not something that anyone had a right to manipulate.

In many cases, however, people who were not actually opposed to euthanasia felt it was not right to consider it in the case of someone with dementia, who was unable to give their consent at the time the decision was being made.

Would accept the right to euthanasia for people able to request it, but not for someone with dementia.

Gender Male

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Some carers struggled with the feeling that their loved one would have wanted to write a ‘living will’ (also known as an ‘advanced decision’) making clear their wishes if they had known that they’d go on to develop dementia. Knowing this they felt thwarted, both by not being able to prove to themselves or others that this was the case, but also by the knowledge that living wills/advanced decisions carried limited legal weight. Advanced decisions can be made to refuse treatment, but not to request assistance in ending life. For example, a person in the early stages of dementia may decide that they will not have a feeding tube inserted if they develop problems with swallowing.

Believes ‘Living Wills should be legalised and doctors encouraged to respect them.

Age at interview 62

Gender Female

Age at diagnosis 61

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One woman, who had written evidence suggesting that her husband would have wanted to die rather than reach the state he was now in, nevertheless persuaded herself that there were still some things in his life which continued to make it worth living.

Lists the reasons why she is opposed to euthanasia for her husband.

Age at interview 62

Gender Female

Age at diagnosis 50

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While carers didn’t feel in a position to ask for someone’s life to be ended, they did feel that they had a responsibility to decide what kind of efforts should be made to prevent death. There are two main situations where the decision whether to intervene or not would increase the chances of survival or hasten death.

The first such situation is to make a decision that the person with dementia can’t be made to eat or drink. In some cases this seemed to be caused by the person actually forgetting how to do it, in other cases it was seen as a struggle with what remained of what had once been a strong will. One carer described how, with patience and ingenuity, she managed to introduce some nourishment and teach her mother to eat again. More often carers would be faced with having to decide whether they were willing for their relative to be fed either by introduction of a naso-gastric tub, a PEG tube into the stomach, or intravenously. Many carers had no compunction about asking that such measures were not taken.

Found ways of getting her mother to eat.

Gender Female

Age at diagnosis 80

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The second situation is the use of active measures to treat illnesses occurring in a seriously demented person. Most carers we talked with agreed that they would be happy to accept the use of antibiotics if they would relieve suffering but would oppose their use for someone who was not able to take them by mouth, where giving them might involve a struggle or use of a possibly uncomfortable IV infusion. Similarly most of the carers we talked with wanted it to be clear that they didn’t expect their relative to be resuscitated in the event of their having a heart attack or a stroke.

These considerations may seem obvious and humane, but some carers felt that it was not appreciated how difficult it was for them to have to make these decisions. Sometimes it was felt that there was insufficient guidance and understanding from professionals, particularly those working in hospitals. Some carers who could not accept the idea of euthanasia worried that there was an inconsistency in their having allowed the use of morphine to make their relative comfortable when they were aware that in all probability it had hastened the end of their life. They were grateful when the decision was taken out of their hands. (For more on Advanced decisions see our section on Living with dying).

Relatives should not have to make difficult end of life decisions. Disputes hospital ethos of saving life at any cost.

Age at interview 53

Gender Female

Age at diagnosis 61

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One carer had told the staff in the nursing home where her mother was resident that, in the event of an emergency, she would much prefer for them to call a doctor than for them to call an ambulance, the implication being that to stay put and to die in peace was infinitely preferable to subjecting her to the trauma of a hospital admission.