With Mandela, end-of-life dilemmas are magnified

Associated Press

CHICAGO

The emotional pain and practical demands facing Nelson Mandela’s family are universal: confronting the final days of an elderly loved one. There are no rules for how or when the end may arrive. Some choose to let go with little medical interference; others seek aggressive treatment. Mandela’s status as a respected global figure only complicates the situation, doctors and end-of-life experts say.

Mandela “is not only revered, he is loved and profoundly admired by people all over the world, and the sense of letting go must be difficult for everyone involved,” said Dr. William Schaffner, an infectious- disease specialist at Vanderbilt University.

In much of Africa, people are considered fortunate to live past age 60. For those who reach old age, death is still seen as sad, but friends and family typically celebrate with big parties to honor a life well-lived. Taking extraordinary measures to keep that person alive would be considered dishonorable, said Dr. Sola Olopade, the Nigerian-born clinical director for the University of Chicago’s Center for Global Health.

If such measures are being used for Mandela, many could consider it “quite painful,” Olopade said, “because those are not the last memories you want to have for someone with such an exemplary life.”

U.S. doctors said Mandela’s lung infection most likely is pneumonia, a very common cause of illness and death in the elderly.

The infection usually is caused by bacteria and causes lungs to fill with fluid or pus, making breathing difficult and often causing fever and weakness. Treatment includes antibiotics and extra oxygen, often from a mechanical ventilator.

In the United States, an elderly person critically ill with pneumonia typically would be hospitalized in an intensive-care unit and put on a mechanical ventilator, or breathing machine, said Dr. J.P. Kress. He is director of the University of Chicago’s medical intensive care unit’s section on lung and critical care. Ventilators often require a breathing tube down the throat, and patients need to be sedated because of the discomfort.

These patients typically are hooked up to feeding tubes, intravenous fluids and all kinds of monitoring machines to check heart rate, blood pressure and other functions. For long stays, lying prone in a hospital bed, they have to be moved periodically into different positions to prevent bed sores; their arms and legs have to be exercised to fight muscle wasting.