What do I say when Mom says "I want to die"?
The right way to respond involves more than what to say to her. We're fortunate that we live during a time when pharmacologic advances are such that no one should have to live with severe pain. Therefore it's critical that a physician with expertise in the treatment of pain evaluate the medication she's taking and work with her to make her as comfortable as possible.
Physicians, nurses, psychologists, and other healthcare providers can choose to develop expertise in treating pain. In order to find such a person locally, ask your own primary care physician to whom he or she goes with questions about how to manage pain. Several national organizations also promote effective pain management and have directories of healthcare professionals with expertise in treating pain. These include the American Pain Foundation and the American Academy of Pain Management.
It's also important to have a psychiatrist evaluate your mother. If her hopelessness is caused by a significant depression, which is likely the case, treatment of the depression will dramatically improve her quality of life. Unfortunately, healthcare professionals often fail to properly diagnose depression in older people. They may assume your mother has reason to be unhappy -- after all, she's had compression fractures and is in pain, and she has likely also lost some physical function. While that all may be true, the stress may have triggered a depression, and the hopelessness that can result can in fact be treated. This means her optimism can return, despite the compression fracture.
Ideally, treatment should include a combination of talk therapy, to help her gain perspective, and antidepressant medication. There's a feedback loop between pain and depression. Interestingly, antidepressants -- even in someone who is not depressed -- can decrease the perception of pain. In your mother's case, an antidepressant might help her with both the depression and the pain. It's also important that her physician evaluate whether she's taking any other medication that's contributing to her apparent depressed mood.
An experienced clinician -- probably a psychiatrist, given the combination of emotional and medical issues -- should also carefully evaluate your mother's safety. When someone is feeling so terrible that she expresses a desire to die, her words must be taken seriously. Even if she doesn't specifically say she has considered taking her own life, the hopelessness she has expressed means she needs a comprehensive assessment regarding her risk for a suicide attempt. It would be tragic if she made a permanent decision about a temporary problem that could be treated.
In the meantime, let her talk about how she's feeling and feel free to ask her if she's considering suicide. This won't put ideas in her head, as many people fear; rather, it will give her a chance to talk about her feelings and thereby feel less alone. The feeling of being alone and hopeless is a dangerous combination. When she's talking to you about how she's feeling, she's no longer alone, and her risk for suicide decreases.
But also know that while talking to you will likely help her, it doesn't diminish the critical need to have her evaluated by a mental health professional.
MY 86 year old Mother would have none of the "let's go talk to someone" answer. She was married for 33 years to my Father who died of cancer, then was married another 26 years to a man who died of cancer. She's wealthy beyond belief, and is in her own home. My sister does her grocery shopping, delivers her medicine, takes her to get her hair and nails done, and her grandchildren and great granchildren visit her almost every weekend. I am in another state and my visits are limited to a few a year. But my Mom is at the stage where she's given up driving, her eyes are going so she gave her checkbook to my sister, she's under 100 pounds soaking wet, she has to use a cane and a walker to get around, and she generally just feels she's had a good life and wants to die. She's on anti depressents, and now when I call she's just in a hurry to get off the phone. She doesn't want to be at home, but she doesn't want to go anywhere. I feel for her but am at a loss as to what to say. She's a Christian so I know she truly knows she can't control when she dies, but I'm afraid she'll starve herself and think that's OK. What can one possibly say to her?
My mother suffered from bipolar disorder for many years, having frequent episodes of severe depression. She was evaluated by her psychiatrist at regular intervals, with several trials of medication changes.
About 6 months before her 78th birthday, following a 6-week bout of severe depression, she told me that she didn't want to live any more because she couldn't handle the suffering she experienced with each depressive phase. She called this experience
After that incident, she began to show increasing symptoms of dementia. She became more physically and verbally aggressive. The psychiatrist made additional med changes, to no avail.
One day, she became so violent that her spouse had to call the EMTs and police because she had knocked him down. She was hospitalized and sedated. She refused to eat or drink. I knew that her living will instructed that she not be given IV's or feeding tubes. She passed away one week later.
Back when she had made the pronouncement that she wanted to die, I listened to what she had to say, but did not try to convince her to see her physician again. I knew that she meant what she said and was desiring that her suffering come to end.
Dr. Robbins' article is okay, but it only presents one alternative in dealing with the wish to die. Every person deserves the opportunity to explore his own way of dealing with the end of his life, utilizing the kind support of family and friends.
Pierre Lavedan MD Palliative Care and Hospice Care Omaha, Nebraska Dr. Robbins has given a very good discussion of how to respond to "I want to die" statements. You could seek out a Palliative Care physician in your area. The physical pain needs to be treated to a level that is tolerable for your loved one. Depression should also be treated. Other types of pain should also be considered. Social pain- the loss of our social functions in society. In the dying process we gradually withdraw from our community and freinds. Then we withdraw from extended family and finally immediate family. A psychologist or social worker might be helpful. Spiritual pain- are there any spiritual issues involved? Seek out your loved one's spiritual advisor. If all aspects of the suffering are being addressed the request to die should be relieved. We want to restore hope. When we are dying, hope transforms from the hope of cure to the hope of relief of suffering and finally the hope of a peacefull death. Not only should we ask "why do you want to die?" but also "What is causing your suffering?"
Dr. Robbins article does have some good advice in it, however it is very plain to see he is a psychiatrist. Why is it sir, that someone whom is perfectly rational, can't have the right to choose their way and time of death? I, for one, believe an individual whom has not decompensated emotionally, does have the right to choose the time and manner of their ascension to the spiritual plain. Especially the people who have no quality of life left, despite all of the pain management and neuroleptic drugs we as MHP's encourage them to take, and quess what? A lot of tmes all these wonder drugs do is possibly nothing except to get bigger and more expensive meals and office supplies, (ie: advertizing materials for the prescribing physician's office, allegedly). I do agree with you that if a person is not of being of a rational mfind when they talk about wanting to die, a psychosocial intervention should be initisted. However if the person is rational, then I strongly believe they have the righ to die with dignity, and the family does need to be there to listen to them, ask questions about family history, and in general tie uo loose ends on all sides before the loved one goes to join with the creator,
I would ask, "If we got your pain under control, would you still feel this way?" If she answers no, then make some serious efforts to control her pain with her Primary care physician. That person may refer her to a pain specialist. If her answer was yes, I would have her assessed for depression. If depression is not a factor, then an evaluation by a hospice agency may benefit her. Hospice care specializes in pain management at the end of life.
Of course, I don't have much medical history on her so I'm saying hospice may be a treatment option if she is refusing medical treatment and is ready to die. The hospice team could educate and support you during this time. I strongly believe, also, that a person has the right to die with dignity and comfort. Also, please look into Advanced Directives (power of attorney, Medical Durable power of attorney, living will, and out of hospital do not resuscitate).
HEy everyone i just need to vent this evening....... we found out my mother has cancer a year ago in that time it has gone from her brest to her bone to spots showing on her liver my mother has never been sick b4 as a kid she had the common cold so to see her like this is heart breaking..... she is going through clemo but nothing has changed just gets worst with every scan, it breaks me to see her up at night vomiting and sick she didn't want to go through clemo again when they found it on her liver but to say the least she is going through with it, as i sit here writing this she is lying here telling me she rather die then go through this any more and that she is sorry :(...... if i lose my mother i don't no what i will do she is only 57 my father is not well and just takes care of her i don;t no how much more i can take
@Anonymous Caring.com community member who wrote starting out "HEy everyone i just need to vent this evening".
Honey, I know that seeing your Mom so fragile is terrifying. My son is going through the same thing with me. I understand your Mother's desire to die. Sometimes my dear when illness takes away our quality of life & we are spiritual people, we know that a better place awaits us once we die. A place of no pain, no chemo, no worries. Good health and a better state of being await us when we join with our Father in Heaven.
I don't know if you Mom is a spiritual woman as you do not say.
As harsh as this may seem, it is her life and she has the right to have it end her way. Calling in Hospice at this point would be the best option for both your Mom & yourself. They can help you have all of the proper paperwork in order and allow your mother a dignified passing. If you have time go to www.livestrong.org there are numerous links that can help you there as well. You might want to place this question under it's own heading as this thread is for AbeW's question. That way you get more input on your particular situation. In the end, as much as I understand that you are frightened honey it is not about you it is about your Mom & her wishes. Let her know you love her, let her know it is okay to move on. You will grieve, yes that is true but you will also know that at least her end of life desires are met. May God be with you all. Jade
It seems to me that healthcare professionals only see pain, disease or depression as causes for wishing to die. My mom will be 92 in less than 2 weeks. She has wet macular degeneration and is leagally blind. Her hearing has deteriorated and we have just order a hearing aid, but I do not expect it to make much of a difference. Mom feels she has no purpose in life. She spends her days mostly in bed getting up only to eat and use the bathroom. When she first was unable to read for herself I registered her with the Talking Books Library for the Blind. At first she enjoyed them very much, but still missed being able to read. Now she has no interest in them at all. I try listening with her so we have something to talk about but she claims she cannot hear the books or me for that matter. Three years ago she fell and broke her hip. She not only got out of rehap, but was walking without the aid of a walker. Now she lets herself get so weak from lack of exercise that she must use the walker all the time. I arranged for physical therapists to come and help her, but she got angry and didn't want to see them or do the exercises. To get her to go out is next to impossible. When I took her for her hearing examination, she curled up in bed and claimed to not feel well. I told her if she did not get up and dressed, I was going to put her in a nursing that day. She got up and dressed, but kept trying to get me to take her back home throughout the visit. I doubt she will wear the hearing aid because she had an amplifier about a year ago but got so annoyed with it, she "lost" it. I expect a reapeat of this.
I had neighbors come in for a dinner. People she has known for years and years. She refused to get dress and came out of her room 3 times. I refused to give her food until she got dress which she finally did because she was hungry! She seemed to enjoy the company but after eating a little, she toddled off to bed again. She gets annoyed if anyone comes to the house, yet wants me to make friends and go out.
She says she wishes her life were over. She can't understand why she is still alive.
She is not in great pain - mostly stiffess from lack of exercise. She is quite healthy apart from her eyes and ears. She is not interested in learning braille, although this is something I would like to pursue in spite of her attitude. Is she depressed? I sure she is, wouldn't you be if you felt cut off from doing anything but eating and sleeping?
I truly do not know what to do anymore. Everything I was once able to get her to do and enjoy, she has withdrawn from. Aside from possibly interesting her in learning Braille, I've no activity to occupy her and stimulate her mind and pleasure in living.
I personally don't believe in pushing our loved ones to do anything especailly if they are up there in age, I've seen way to much suffering in my family and the 2 nurising homes I worked in...never force or threaten them, that is not very nice and does not help them. just one persons opinion.
Anonymous and 91 yr old mother. I guess the first thing I would say is this is about "her and her wishes" not you and yours. My Mom is in a hospice in home care facility at age 96. She can barely see (dry macular degeneration), can barely hear with the strongest aides available, can't feed herself (weak/hands shake too much), can no longer stand or walk. She is dying from end stage congestive heart disease. At 96 she has had a good long run and it would be selfish of me to try to keep her in this world. She is kept pain free, but is now suffering from really bad sundowner's syndrome and keeps everyone there awake all night. Why would I want her to continue living like that? Learn braille? Has she seen a good geriatric doctor? Does she have serious health problems? Maybe she is just tired of living and wishes to find peace from loss of quality of life and is/has reconciled herself that the end is inescapable. I can't tell you my story here as it is too long and I really was looking for a site to hook up with for some support on what I am seeing as I visit with my 96 year old mom and watch this complicated stage of the process of dying and leaving life as we know it. Now if someone could direct me to an online group where people discuss their experiences and try to help others as we each reach those step by step changes that occur as death nears I would really appreciate it. Diane
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