Mrs. M

Mrs. M is an 83-year-old woman with COPD and a history of one previous stroke. She has chronic medical problems including degenerative joint disease, osteoporosis, and coronary artery disease. With extensive support from her family and a home health service, she has been able to remain at home in spite of her worsening conditions. Over time her skilled nursing needs increased, and now, care at home has become very difficult and increasingly impractical. For the past year, Mrs. M has adamantly refused to move to a nursing home, though her family believes admission is the best option for her. She does not want any more aggressive care. She saw one of her friends live for months on a vent, and she is afraid that she will get stuck in a similar place.

In the last month, it has become clear, even to Mrs. M, that the family and home health service can no longer meet her needs at home and she needs to move to a nursing facility. Reluctantly, she has agreed to consider a nursing facility if her children and social worker can find a place she agrees is suitable.

Last week, Mrs. M mentioned to you, her home health nurse, that she recently read a newspaper account of a woman who chose to stop eating and drinking so she could die on her own terms. This week, Mrs. M updates you that her children have found a facility they think is “nice”. After she tells you about this development, she confides in you that she wishes she could end her own life and that she does not want to move to a facility. Towards this end, she is planning to refuse food and water and to stop taking all medicines other than pain relievers. Her goal is to achieve a quicker end to life and wants to avoid unwanted aggressive care. You are concerned about this choice and are unsure how to respond or what to do.