In August, I take my 97-year-old mother to her cardiologist to discuss the expiration (come October) of her pacemaker's battery. She is limited to a wheelchair that she pedals with her feet against the floor, and she is prone to UTI's that cause sundowning (paranoia, anger, irrationality). Without a UTI, she is pretty coherent (can understand the benefits and costs of a new battery), but she has almost no short-term memory so can't track a conversation for more than a minute at most. In the past three years, she has suffered broken wrists, shoulder, sacrum, and elbow, so the board & care where she has been living the past few months is careful to keep her off her feet except when transferring her between chairs or bed and chair. Recently she had to be taken to the ER for syncope (her BP has always run low).
Several months ago, the cardiologist--tactfully--warned against the battery replacement because of the invasiveness "and her dementia." But the decision ultimately would rest with her. However, if she lacks capacity and if others hold PoA/Healthcare Directive, isn't the decision shared? In brief discussions so far, she seems ambivalent. I foresee more ER visits and systems collapsing if we let the battery expire but a-long-term, bed-ridden, infirm state if we replace it. Suggestions?
Doctors are often loathe to tell you what to do; many feel that it puts them in an ethical dilemma. My husband and I have had some success instead asking our doctors "what would you do if this were you/your loved one?", and a lot of time we can get a better answer when the question is phrased that way.
FYI, my husband is presently in hospice care. There's no way I'd put him through what you're anticipating for your mom. Do get a consultation from hospice; mom doesn't have to know who they are when they visit. And think seriously about canceling the August appointment with the cardiologist.
Good luck with a difficult situation.
If this woman's PoA agent is not active or durable, then she gets to decide. She won't remember the tactful or gentle discussion from her cardiologist.
My mother had a pacemaker and I think if it was my mother I'd let her choose. My mother did not have dementia and fully intact short term and long term memory up until a few days before she died. She would have wanted the right to make that decision.
In your case it sounds like your mother has some memory issues going on and I'm not sure she is capable of making the decision. Replacing the battery is just going to prolong her misery. She is not going to get better and her quality of life is just going to get worse. Maybe it is time to let nature take its course.
Does she have a DNR? Read the directives she signed off on.
I'm actually surprised the cardiologist made this recommendation not to replace the battery but I respect it. Sometimes it is best to acknowledge when enough is enough.
Best of luck as you navigate this.
On the other hand, my mother was in Memory Care with advanced dementia, CHF and wheelchair bound with terrible neuropathy in her legs and feet. I prayed daily for over a year for God to take her. I just didn't want to be the one to make that decision for her.
Best of luck to you.