For the sperm case, the breastfeeding case and the kidney case, IMO the choice ought to be made by someone who represents the interests of the impaired person, and who doesn’t benefit from the proposed action. It’s all too easy to deceive oneself into believing that he would have wanted another child, or she would have wanted to donate the kidney, when in fact it’s your own wishes and not the impaired person’s wishes you’re considering.
That’s exactly what I think should happen with the impaired spouses and sex. It’s all too easy to deceive oneself that s/he wants this, or would have wanted it, when in fact you want it and you don’t have a clear idea of what s/he wants or would have wanted.
I oppose putting a child to the breast of a comatose woman. IMO nursing on a comatose woman would be bad for the baby. If the decision is made that the breastfeeding woman should continue to supply milk for her baby-- and I think in most cases, it’s reasonable to believe that the nursing mother would have wanted to continue feeding her child-- that milk should be pumped and the baby fed by a conscious person.
My memory is a bit hazy over this incident, but after our last kid was born by C-section the Doc asked us if we were planning on having any more kids. When we said “no” he asked DW if she wanted him to tie her tubes while he was fixing the incision. After we said “yes” he asked if we were sure. I wouldn’t swear that he said exactly what I recall, but I remember being surprised by his questions. I think he said something like “what if something happens to your kids? are you sure you won’t want to get pregnant again?”. I will have to ask DW if he asked about her getting married again.
So, what exactly do I need to document to make sure that – if I develop dementia – that I would still want to have conjugal relationships with my husband, and that I trust him to make these sorts of decisions for me? And for that matter, that if my D, H, or grandkid needed a kidney that he’d have my permission to consider my kidney?
I trust my husband to make good decisions for me in the event I’m incapacitated a whole lot more than I trust random nursing home staff, doctors, or psychologists.
It’s like those terrible monkey studies where baby monkeys were given the choice between feeding on a cold non-inviting device or cuddling with a warm responsive device that supposedly simulated a mother monkey’s loving touch. The monkeys choose the warm, loving touch over nutrition, with horrible results. (I’m probably bungling the details).
Anyway, I think babies need loving interaction during feeding and could potentially have major attachment issues if they were fed at the breast of a comatose patient. (These hypotheticals are getting very far out there.)
Sex between spouses is different than all these other hypotheticals because, for most couples, it is a way of expressing love toward each other. An impaired patient may well be capable of giving and receiving love and for all we know communicating thru loving touch may be the last form of communication to go. I would not want to deprive an impaired person of that ability to give and receive love, and think there is a giant gap between a mentally impaired person (say with dementia) and someone in a coma.
I see it as a disability rights issue. We’ve come very far in this country with respect to the right to marital privacy (including the right to procreate) for severely mentally impaired adults. I would hate to backslide.
Anyway, if any relative thinks that a loved one is being mentally or physically abused by a spouse, he or she can always go to court and attempt to get a conservator appointed, and then, if substantiated by evidence, get a court order limiting contact.
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Anyway, I think babies need loving interaction during feeding and could potentially have major attachment issues if they were fed at the breast of a comatose patient. (These hypotheticals are getting very far out there.)
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Well, think about it…no one would have a baby latch onto a comatose woman and just leave the two. No. Someone, would be holding the baby in place, stroking the baby, etc.
"For the sperm case, the breastfeeding case and the kidney case, IMO the choice ought to be made by someone who represents the interests of the impaired person, and who doesn’t benefit from the proposed action. "
Then you run right up against - should a spouse or adult child be able to make a decision to pull the plug when they might benefit from an inheritance. (Let’s assume said spouse or adult child are good people and sincerely motivated by what the ill person has repeatedly expressed,)
We are going to face this in my family soon. My 95 yo gmother won’t be for long. Despite repeated pleading, she refuses to get a living will, etc. but we absolutely know that she would not want heroic measures used to prolong her life. My mother, sister and I are her only relatives / heirs. Who else should make these decisions?
^^ @pizzagirl so sorry to hear that you may soon be losing your beloved grandmother. How wonderful that you’ve had her for all these years!
When it came time to decide to discontinue treatment for my unconscious mother, it was my siblings and I who made the decision …and we were allowed to do so even though obviously we were going to immediately inherit her estate (my dad had passed the previous year). We gave mom the best shot to recover and when the doctors said that she was at the point of no return, we still waited a few more days just in case the docs were wrong. The docs were right as her organs were shutting down. Treatment was discontinued and she passed a few days later with all of us by her side.
No, but it would be a good idea for the doctor to ask the woman what she would want to do if her children died. Yes, it’s horrible to contemplate. It is also horrible to contemplate being childless when you want to be a mother. No one is saying that the children would be “replaced.” but as the mother of an only child, I know there is a big difference between being the mother of a child and not.
Obviously this sort of thing has to be approached delicately. One would hope that the doctor had developed a relationship with the patient and spouse, and that this was part of a thoughtful process. In my experience, doctors who deal with this kind of thing often have written materials for people to take home and read and discuss out of the fraught atmosphere of the doctor’s office, where even very calm and rational people often can’t come up with questions they need to ask.
Nursing from a comatose mother? That’s one of those ick factor things. Does it harm the mother? Probably not, if the nutrition and hydration required by lactation can be replaced. Does the baby derive any irreplaceable benefit from breast milk? While I certainly think it is preferable to breastfeed, the fact is that the baby would do just fine with formula fed in the arms of a loving father or grandparent or caregiver. Millions of us have.
What if it’s not nursing from a comatose mother, but from a mother with dementia? (Does it ever happen that a dementia illness strikes someone young enough to be nursing her baby? I honestly don’t know.) I have very mixed feelings about this. On the one hand, I’m really pro-breastfeeding and nursed all my kids a long time. On the other hand, bodily autonomy and awareness are so important in my mind.
I was actually contemplating @Pizzagirl 's post this morning (from a while ago, about how she would want to be in her DH’s arms under any and all conditions just to feel that connection) while I was hugging my DH and I thought to myself, would I want to be hugged by him if he didn’t know who I was? And it made me feel extremely creepy, and I don’t think the answer is so clear, at least not for everyone.
@fretfulmother, absolutely, it is going to be an intensely personal thing, which is why I think that outsiders should generally refrain from interfering. Unless there is physical or emotional distress.
In the Rayhons case, as I think we all agree, she definitely knew who he was and there was no evidence at all of abuse or distress.
Dementia can be intermittent, it can be due to a temporary condition or a long-term but variable condition.
These stories tend towards “you’ve got dementia, that’s the end of it, it’s just going to get worse” yet I have seen and talked to people lucid one day and not the next day. My father does not have dementia, but he has intermittent episodes, goodness knows why, where he is confused about what day it is and what his schedule is (and yes, he has been evaluated for dementia).
A concern is that the “nursing home staff determined she could not consent to sex”. Did they determine she can’t pick out what food she likes? Or what she wants to watch on TV? Or how about if she is in pain or not, and needs medicine?
I’m worried that it was just too convenient for the nursing home staff to say that because it was easier for them. This at least has drawn attention to the issue of nursing homes (and hospitals) and whether “conjugal visits” should be allowed at all, if it is not a single room.
Doesn’t a judge decide if a person is competent or not, and what they are competent to do? Or if you have POA, do you have full reign over what a person can and can’t do (like - hey grandma - can I have a kidney?)?
M2CK - actually my grandmother is ok right now (just frail), but we do know that she can’t live forever, but thanks for the kind thoughts!
I was more just pointing out the flaw in CF’s thinking that decisions for people who are unable to voice their own decisions should be made by “people who won’t benefit from the decision-making.” That flies in the face of how these decisions get made every single day in nursing homes across America - by loved ones (specifically spouses), who are presumed (in the absence of evidence to the contrary and / or living wills to the contrary) to know what their loved ones would wish to do. Even if they might “profit” from it, e.g., stand to inherit if care is discontinued. That’s just the best solution we have. I don’t know why you would remove sexuality / intimacy as some kind of special case.
Re something like the bfing example - presumably the spouse of the woman would be in the best position to know whether she’s one of those over-the-top unless-I’m-six-feet-under-I-want-to-breastfeed types or whether she’s reasonable about it.
Isn’t this related to those horrific stories we heard last year regarding women who were in pg who were in comas, where their husbands didn’t want them to continue to carry the pregnancy to term and by all accounts were expressing what their wives would have said if they were able to? CFang, I assume you think that in the absence of a directive to the contrary from the woman herself, the husband should be able to determine whether the comatose wife should continue to carry or not-carry a pregnancy to term – not some disinterested party who has nothing to gain or lose?
I am one of those psycho extended breastfeeding mothers. I would unquestionably have wanted my kids to receive my breast milk if I were in a coma. I am confident that my husband knows that.
Well, I’m pretty confident that all of our spouses (assuming good marriages and good will, not abusive situations and the like) know what our wishes would be if we were incapacitated. I trust my husband enough to make all decisions for me if I am incapacitated and that he will execute those decisions with my welfare in mind – so I don’t have a need to “isolate” the issue of intimacy and have a special clause in there that that’s the one exception to the rule. Others, like CF, may decide to write such a clause ahead of time, and that’s their prerogative. But in my mind, I wouldn’t separate this from anything else. I trust my husband to know and carry out either my expressed wishes, or what he, having known me for umpteen years, would reasonably believe to be my wishes in all of these matters. That goes for (hypothetical) breastfeeding a baby or donating a family member or getting a much-longed-for tattoo completed or pretty much any hypothetical we could all come up with.