Friday, July 15, 2011

When "best" or "right" isn't so simple

We'll call it a simple test of libertarian principles. It goes something like this:

My dad's dying. I think he knows it. In fact, I'm pretty damn sure he knows it. He's a bright guy, not the warmest, fuzziest guy in the world, but a bright one. And lately, he's been all fucked up.

Actually, I shouldn't say "all fucked up." That implies a level of incompetence that he has not reached. In fact, I don't think he's incompetent at all. He is just, as a nurse in a hospital once described him only 10 minutes after meeting him, "the stubbornest man I ever met."

Anyway, he is severely visually impaired and has a host of long-term orthopedic issues that have left him, at age 85, hobbling around a multi-story house (where he lives alone) with the assistance of a walker and one of those stair-chair thingies that gets him from the first to the second floor. As I have said to him for years, based solely on his vision and orthopedic problems, "Dad, if anyone forced you to live this way, they'd be arrested for elder abuse." He fell last year, spent two days on the floor before he called for help, nearly died, spent four months in nursing care and assisted living, where he was, as the Brits say, "safe as houses," and then he checked himself out to go home. He's been there since. It's a mess, but a barely-containable one with the aid of some friends who do his shopping for him (I live over an hour away and my only sibling much farther than that. I go over every few weeks and pay bills and and balance his checkbook for him).

But lately, it's different. And by "different," I mean worse. There was the freakout call at midnight about a month ago, complaining of a life-threatening condition that disappeared when EMTs arrived. There was the sudden inability to remember his heretofore favorite grandchild's name. Then he wished me "a belated happy birthday" two weeks early, but he hadn't forgotten when my birthday was; he thought the date was 14 days in the future. Then there's the sudden inability to work any device that requires pushing a button -- his alarm system, his TV remote, the phone, the radio. You get the idea. It's a mess. Then I got a call from his pharmacist that the delivery guy found him strangely distant and not very talkative. What really blew the guy's mind was when the man who usually locks his house down like Fort Knox said,"Do whatever you want," when asked if the delivery guy should lock the front door as he left.

So I convinced my dad to go in for an evaluation and the doc sent him to a neurologist. And both of them agree on a couple things: (1) something's wrong and (2) he is not incompetent to decide his own course of treatment. And I think they are correct on both counts. So, the neurologist gave him a list of tests to get done, starting with an MRI of the brain and finishing with a whole host of others, and he refuses to get anything done. "It doesn't matter," he says. "The result will be the same. And I am not going to live somewhere else."

And there's the kicker. He has been resolute since my mother, eight years his junior, passed away in 1997: he wants to die in this house, not in nursing, not in assisted living.

Someone -- more proactive, more intrusive, less respectful of his wishes and more prone to do what's objectively "sensible" -- would step in, exercise the power of attorney that exists and take over, sending him off for testing, to live elsewhere, etc.

I don't think I can do it. And I don't think I should, not while he is still mentally competent. There is no doubt that the "best" place for him is somewhere safer, but it very clearly is not what he wants. And -- and maybe I should have said this several lines ago -- if he changes his mind, he has one of those beeper/emergency things around his neck that he can press and 911 will be there in minutes.

So, really, who the hell am I to tell him otherwise? Oh, I've made the pitch. Trust me, I've made it until I'm blue in the fucking face, blood pressure through the roof and emotionally spent. He's my father. As much of a pain in the ass as he can be, I don't want him to die in a puddle on the floor.

But he would vastly prefer that to the hospital/nursing alternative.

So we get back to those libertarian principles. It doesn't mean much if I spout off here or anywhere else about freedom and self-determination and all that if, when the chips are down, I can't let a still-competent old man decide to fade away in the lonely shadows and likely get discovered days later.

Yeah, it's going to be a mess. No, it's not fair to me or whoever finds him. And, in the end, I don't think any of those things control the decision. Not as long as he is competent and sticking to the same position he has always had.

So I will keep calling him, and I'll go pay his bills and balance his checkbook. And I'll wonder what the hell his problem is, and swear I will never be like that. But until he really and truly isn't around mentally any longer, I won't override his will.

And, odds are, it's going to be a mess. In fact, it already is.