After 11 years on dialysis, woman makes her life-or-death decision

April 6, 2007

'I'm just plain tired of things not going right'

After 11 years on dialysis, woman makes her life-or-death decision
By BILL KETTLER
Mail Tribune, South Oregon

Life wasn't easy for Mary Schurpf.

She raised five kids on her own and drove a forklift to pay the bills. An industrial accident left her unable to work in midlife, and soon after she turned 60, kidney disease forced her to go for dialysis treatments three times a week.

There were other health problems, too — coronary bypass surgery, an aortic valve replacement and strokes that clouded her memory. Complications from surgery in 2006 left her incontinent and paralyzed from the waist down. Last October she moved into a Medford nursing home.

Toward the end of March she decided she'd had enough. At 72, she stopped dialysis, knowing her decision would end her life.

"I'm just plain tired of things not going right," she said at the time.

"I've been on dialysis 11 years now, three times a week," she said. "I'm tired of not being comfortable. I'm tired of not being able to get a good night's sleep."

Eight days after she stopped dialysis, Mary Schurpf slipped into a coma and died.

People make conscious decisions to shorten their lives far more often than most realize, said Dr. Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University. Tolle said OHSU researchers found that the overwhelming majority of Oregonians make a decision near the end of life not to pursue some sort of medical treatment such as chemotherapy, radiation or dialysis.

OHSU researchers talked with 1,189 family members of people who died of natural causes after a long illness between 2000 and 2002. They found 79 percent of those who died deliberately stopped some kind of treatment or did not begin a new treatment that might have prolonged life. Their findings were published in the Journal of the American Geriatric Society in 2004.

Tolle said stopping dialysis is not all that different from deciding whether to have another round of chemotherapy at the end of a series of cancer treatments.

"It's very common," she said, "but it's not discussed much outside the medical community."

People who choose to stop dialysis are "almost without exception, ill enough and feel terrible enough, and they're miserable enough, that nothing is helping them anymore," said Jack Richard, a social worker at Rogue Valley Dialysis in Medford.

"When people are really ill and their body starts breaking down, they just feel rotten all the time and dialysis becomes a kind of torture," Richard said.

Richard estimated that about one-third of dialysis patients who die made a conscious decision to stop treatment before the end of life. He said the decision to stop dialysis usually comes only after a long period of soul-searching and conversations with family members, physicians or religious counselors.

Most people are at peace with the choice once they make it, he said. "They're clear, they're sure, they're ready, and that's fine."

At Schurpf's age, she rejected some of the options that a younger, healthier person might consider. She didn't want to take a kidney from any of her children, because she feared they might one day suffer from the same condition that afflicted her — polycystic kidney disease, a genetic disorder characterized by the growth of numerous cysts in the kidneys.

Her medical history also weighed against a kidney transplant.

"I've had so many surgeries," she said. "I can't see going through another surgery. I probably wouldn't survive it."

Schurpf said she thought long and hard before stopping dialysis. "There have been times I cried myself to sleep wondering if this is the right thing I'm doing," she said, but at the end she had no doubt.

"I'm very at ease with this, and I can't understand why," she said two days before she died. "It boggles my mind."

She rejected a visitor's suggestion that she might be depressed.

"No," she said emphatically, "No.

"I have a schizophrenic daughter," she said. "I know the difference between depression and things like that. I am not depressed, but I am very tired of being on dialysis three times a week for 11 years, and not being able to see a future other than the way I'm living now. Angry? Yes. Tired? Very tired? Yes."

Her son, Steve, who lives in Grants Pass, visited often during her last days, and friends from the nursing home dropped in. Hospice workers explained that she would gradually feel more fatigue as the toxins accumulated in her body and assured her she would be treated for any pain. One day a social worker brought her a banana split, a treat that had been forbidden while she followed a restricted diet for her kidney disease.

Last Friday, she was alert and pain-free while she reflected on her life. By Sunday morning, she was gone.

"She just went to sleep Saturday night and never woke up," her son said. "She's in a better place now."

She'll be buried in California, where she lived most of her life.

Reach reporter Bill Kettler at 776-4492 or e-mail bkettler@mailtribune.com.

URL: http://www.mailtribune.com/archive/2007/0406/local/stories/decision-to-die.htm