M & M’s for Dementia: Morphine & Marguerita’s Are A Good Option

A woman was in our Palliative Care Unit dying from Alzheimer’s Disease and I was talking with her daughter about what she wanted if she were to get Alzheimer’s herself; there’s an increased risk of the children developing it if a parent has it.  She said all she wanted was “M&M’s”!  I thought she meant the candies.  “No” she said, “Morphine and Margueritas!”

She had been caring for her mom for several years, watching the disease rob her of the person she had known for 55 years:  her mom was no longer the same individual, knew none of her family, and eventually became bed-bound.  Her quality of life was zero in her daughter’s eyes.

The daughter experienced with her mom her loss of dignity and did not want to have her own children go through it if she were to get Alzheimer’s.   Therefore, she made the decision – and wrote it in her Advance Directive/Living Will – that if she was diagnosed with Alzheimer’s, once it reached the middle stages she was not to have any treatment or drug which might prolong her dying unless it helped her to live more comfortably.

This meant for example, no antibiotics if she developed pneumonia. A hundred years ago, pneumonia was considered the “old person’s friend”.  Grandma or grandpa were worn out, couldn’t work like they once did, thought they were a burden to their family, had constant aches/pains, and were “ready to go”.  Pneumonia came and was the most common cause of death.  They died peacefully at home.

Now, we interfere in that natural journey by giving them antibiotics which, in “curing” the pneumonia, may prolong the dying and subsequently add to suffering.

Because there is no cure for dementia [see article this website for more information about dementia] and it will be fatal if another disease doesn’t cause death first, and because it causes so much distress for both patient and family, many are now choosing to avoid any treatment which may prolong suffering and diminish personal dignity.  They are requesting: “no antibiotics”, “no surgery”, “no drugs except for comfort” – and that’s where the “M&M’s” come in.

This daughter made choices which would help reach her personal goals.  She wanted only something which would keep her free of pain and anxiety and which would allow her to enjoy her family and remember them as long as possible.  For her, that meant morphine, or some other pain killer when she needed it; and a daily Marguerita – because she enjoyed a drink at supper time and it helped her relax and socialize better.

Each person can plan for their own end-of-life.  People need to know that they do have choices.  What would you prefer:  “to live” or “to be kept alive”?