Expert: Paula Damgaard - 2/6/2009

Question
My mother is 94, living in an assisted living for persons with Alzheimer's confined to a wheelchair because of slow recovery of two broken hips. She seems to be mid stage and has been almost a year. She takes Aricept which when started two years ago made a noticeable difference - she got back to reading again for about 5 months - and she takes namenda. Someone suggested to me that since her money may run out in about 18 months I should consider taking her off those drugs to hurry up the final stage. While it would be hard I always thought that if she outlived her money I would retire and bring her home with me. I go back and forth about what her life quality is. When do you make the decision to end drugs like aricept or Namenda. It has not been something the medical folks can talk about here. To me this is an ethical dilemma as my mother would never want to be in this situation or put me in this situation, but when I visit every other day we sing old songs and can laugh together so there is some quality. How do I think about this or is it too early to?

Answer
Hi Ellen, you are absolutely right that this is an ethical decision.  Not one easily answered.  I think there are many things to think about.  As long as you think your mother is having good quality of life, then you should leave things alone.  This won't last forever.  So at some point you are going to have to ask yourself, would your mom be happy to see herself as she is now?  There is a study out that shows that Aricept does prolong a patient's life, something else to think about.  

I think that we now live in a world where we do everything to give people quantity of life and disregard quality.  That is probably why the medical community in your area can't help you here. You are really going to have to be the driver in your mom's care.  You have to be secure in knowing what your mom would want and then tell it plainly to her doctor.  You will have to tell him you want comfort care and that is it. Then you can focus on making her days the best you can right now and let her go when it is her time.  It used to be that pneunomia was the old people's friend because we didn't have these high powered antibiotics that would make people live so long.  Now they live until the disease totally destroys their brains and they can't fight anything else off no matter what you treat them with.  However, they are also totally bedridden and infantile.  

I hope this helps you.  Please know that my thoughts are with you.  Having made this decision for my mom, I know how hard it is!  Keep in touch and let me know how you are.  Paula