Mr. Diaz had always been an active and independent person who.

Mr. Diaz had always been an active and independent person who handled the family finances, volunteered in his community, and could handle any home repair need that came along.  Following his 80th birthday, Mr. Diaz began to contemplate the reality of his eventual death.  He had quit smoking at age 55, but his emphysema continued to worsen and Mr. Diaz had already been hospitalized twice with pneumonia.  He knew that he would never wish to be kept alive on a mechanical respirator and feared that he might die in pain and be unable to communicate his wishes.  Mr. Diaz decided that it was important to express his wishes in writing and to share them with his two daughters, his wife, and physician.  Included in his living will were directives to his family about his preference for cremation and a simple funeral at a location owned by a man he trusted.  Next, he sought the counsel of an attorney to safeguard the financial security of his surviving spouse and arranged for long-term care insurance should the need arise in her old age.

Mr. Diaz continued to live an active life for the next 10 years until he was once again hospitalized for influenza complicated by pneumonia.  After several weeks in intensive care and rehabilitation, Mr. Diaz was able to return home.  Mrs. Diaz kept her promise to care for her husband and keep him from going into a nursing home.  For the next 3 years, she provided companionship and care while Mr. Diaz became increasingly more dependent.  On several occasions, he told his wife that he wanted to “go home”.  Mr. Diaz refused to have outside caregivers come into his home, and so Mrs. Diaz soon was unable to leave the house for more than a brief period of time.  Mrs. Diaz became isolated and depressed, and began to reach out to her friends by learning to use e-mail.  Eventually, Mr. Diaz became very weak and fell when trying to go outside.  He broke several ribs and was in severe pain.  After several days, he agreed to go to the hospital where he could receive adequate treatment to control his pain.  His physician ordered morphine to manage Mr. Diaz’s pain, and conferred with the family about their wishes for recovery.  Mr. Diaz’s daughters and their spouses agreed that the time had come to let Mr. Diaz die in peace, and he passed away several hours later.

Critical Thinking Questions

1.  What do you think Mr. Diaz meant when he told his wife that he wanted to “go home”?

2.  Why do you think Mr. Diaz refused to have outside caregivers in the home?

3.  What resources might have been helpful to Mrs. Diaz?

4.  What role did Mr. Diaz’s advance directives play in the decisions made about his care during his final hours?

5.  How might hospice services have benefited this family?

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