Should I let me father-in-law smoke if it means he'll take his pills?

3 answers | Last updated: Oct 05, 2016
A fellow caregiver asked...

I care for my father-in-law, who has just come home from a 4 month hospital stay. In June of 2010 he had a diagnoses of small cell lung cancer. July he started a month of radiation. In Sept. He developed pneumonia. He was admitted in to the VA Hospital and was told he recently had a mild heart attact. 2 days later he had a stroke. He recovered very well. He has short term memory loss, but walks with help of a walker, and talks. Now my problem is it is March and he has been wanting a cigerette.I won a couple battles. He stopped eating the end of Jan. and then stopped his meds. Now here we are the begining of March, and he has stopped his meds again. I Just told him I will buy the smokes if he takes his meds. I don't know what else to do. He has many health problems, besides the cancer. He has COPD, (on a good day he has 40% lung capacity). I don't want him to smoke, but what can I do? I can't force the pills down his throat. I realize, to him, this is about having "control" in his life. Haveing a "say-so" in his actions. What can I do? Buy the cig's so he takes his meds? It seems like a no win situation.

Expert Answers

Bonnie Bajorek Daneker is author and creator of the The Compassionate Caregiver's Series, which includes "The Compassionate Caregiver's Guide to Caring for Someone with Cancer," "The Journey of Grief," "Handbook on Hospice and Palliative Care," and other titles on cancer diagnosis and end of life. She speaks regularly at cancer research and support functions, including PANCAN and Cancer Survivor's Network. She is a former member of the Executive Committee of the CSN at St. Joseph's Hospital of Atlanta and the Georgia Chapter of the Lymphoma Research Foundation.

I have seen this before -- you're not alone in bargaining with the patient to do things that are GOOD for them. It doesn't seem to make sense. However, there are many considerations behind it: Could they clinically depressed? Are they fatigued or in pain? Have they given up on a cure or on life in general? Often, if you can get these conditions addressed, patients have a renewed sense of life and start to help themselves.

From what you say, it sounds like his quality of life is not so great: difficulty breathing, walking with a walker, extended hospital stays. Have you had a discussion with him on how he feels about all of this? I would encourage you to ask him what else he'd like to accomplish in his life and how you can help him do that. Encouraging him to keep living may be difficult if he doesn't want to.

I know these are serious discussions, but you need to understand where your efforts are best utilized. Maybe it's not the right thing to do to force him to take meds. It's your job to understand his needs and give him comfort. While I don't condone smoking, it may relax him and counter some cravings, which will add to his quality of life. At this stage, that may be the best way you can help him.

Community Answers

A fellow caregiver answered...

I actually have to agree. Depending on his age and life expectancy.

My dad was a smoker. He was dying of a form of skin cancer and it affected his throat area. He found the warm smoke to be beneficial for the pain and the truth was he wasn't going to die a day sooner or live a minute longer if he smoked a few cigerettes now and then. We had restrictions the cigerettes were not smoked without suppervision, because we didn't want him burnning the house down around him and my mother.

I honestly don't regret letting him have a few smokes. Honestly I have often said it standing on my head in the corner would have made him feel better, I would have done that too.

Same for my mom. Smoking wasn't her vice, it was sweets. and once she was leaving us for sure... I didn't care what she ate. My thoughts were let her enjoy what she likes. If she wanted chocolate cake for dinner.. let her have it. she didn't really need the peas and carrots any more.

God Bless and I hope this helps.

Ca-claire answered...

I can understand how difficult it is to get our older loved ones to take good care of themselves.

My father is 92, and recently I had to take him to the ER because he fell and hit his head (automatic CAT scan after age 75, for those of you that are unaware). They ended up admitting him, because his BP was unstable and he was dehydrated (like almost every senior I know). Automatically, they put him on a low salt, low fat diet. Really?! at 92, my attitude is (Dad is not overweight), at that age, he can eat anything he wants as long as he eats plenty! Took 24 hours to get the Dr. to drop off those constraints. Kind of like the Dr. that put him on simvastatin at 88. Really!!!! as if that's going to keep his arteries from occluding the 3% they're open?

Discharge nurse had a long discussion with me about his care, and she actually told me she applauded the way my siblings and I feel about Dad's care. We are being realistic. We have a POLST (Do Not Resuscitate) Order on Dad, and know his wishes, which is no extending his life. We have Dad down to a minimum of medications to keep his blood pressure stable, and to keep his acid reflux down (28cm hiatal hernia-all his stomach in chest cavity).

I keep almonds and snacks like caramels and payday snack size candy bars for Dad to try to tempt him to keep weight on!