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My 84-year-old father has been diagnosed with six dental abscesses after already losing two teeth, one with a crown, which he hid from my mom under a placemat on the dining room table. His breath smells of the tell-tale pus odor, and two dentists--the regular dentist who took the evaluation x-rays, and the oral surgeon have stressed to him the serious state of his mouth and the need for immediate, life-saving treatment. The infection has advanced to the level where sepsis could occur within, at the outside, three weeks.



Despite both the dentists and myself (I work in laboratory medicine) laying out in gory detail the end-point of not treating his multiple infections, my dad has announced that he won't undergo treatment. Even when I said to him, with tears in my eyes, that he is essentially choosing to commit suicide, he was unmoved. I was unable to reason with him, as he is of the belief that he will be healed by divine intervention.



My mom, my sister, and myself have accepted his decision, since we can't *force* him to receive life-saving treatment, but we are all now filled with sadness that the new year will begin with the messy, septic death of my dad. Any advice on support for our trio would be appreciated.

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I suggest you take the time to consider his Quality of Life . I spent 6 years watching my man die a little each day . He was also non compliant in all the rest of his illnesses. It was’t until I joined a CareGivers group that I began to understand what was happening . He did not believe there was any issues with his decision making . It was suggested that he visit a neurologist. He went , only to prove to his Primary Care, that there was nothing wrong with him .. That was the beginning .. It started with Mild Cognitive Impairment. As time passed ( with the help of my group ) I learned a new word.. Anasagnosia …
He truly believed there was NOTHING wrong with him .. It is not the same thing as denial . It was real to him in the reality HE lived in … It was not easy , but I learned to stop taking the things that were happening as being directly aimed at me . It was the disease. . I watched his Quality of Life fail . All the things he valued in his life were slipping away . All the things he loved to do were disappearing. There came a time that with the help of the doctors and my therapist , I was able to step back and just keep him comfortable and safe. Because of the disease he was NOT ABLE to do anything different than what he was doing .. Over the years I slowly and quietly made sure the paper work was taken care of . I hope there is a POA out there . I was fortunate that it was signed before he got bad. It was a long hard road , a 6 year road that ended in October. I am still dealing with Guilt and Relief . I could have been less frustrated near the end . I am feel guilty because of the amount of relieve I feel . I wish I knew then what I know now. I feel my CareGivers meetings over the years have helped maintained My sanity .They CAN NOT change but WE can change our reaction to them .
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Try to find peace with yourself, you have tried you're best at trying to convince you're father. My advice would be that if it is out of you're hands, and you know you have done you're very best then that is all you can do, try to remind you're self that you did you're best, not everything is within control especially when we wish it to be, it is okay to be emotional.
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Try This Have him gargle with a Glass of warm water Mixed with a couple Teaspoons Of Sea salt and a Tablespoon Of Hydrogen Peroxide - It will help Kill The Infection . Do this a couple times a day . Next if He is In Pain Put a Dollop Of Arnica Gel on a Cotten Ball and Have him Bite Down and Hold where it Hurts . I have cured many a tooth ache This way . Place some Lavender Oil Behind His ears for relaxation. Do not Use Whitening Tooth Paste either . I had something similar Happen My Brother he went through chemo the main Tumor died and he had a chance of Living with Immunotherapy . He chose to start smoking again and was dead with in a couple Months . The advice I got from the therapist " This is His life let him Make the choices . " and I had to Let go .
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He is living his life on his own terms. I know this sounds harsh but leave him to it.

If he is no longer of sound mind, why prolong his misery anyway? He’s not going to get better.
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I don’t have any advice but I am in a somewhat similar situation. My dad has frontotemporal dementia. He does not brush his teeth at all and his diet is very minimal and appalling (he eats one bowl of ice cream per day and little else, including almost no liquids), but he will usually go to doctor appointments, and even (to my surprise) said his tooth hurt about 18 months ago and agreed to go to the dentist to get it pulled. But he does a lot of other disgusting and self-neglect things and my mom refuses to intervene. I think he is likely to die from whatever combination of neglect, disease, and dementia and I do alternate between many negative emotions (frustration, sadness, anger, self doubt) and struggle with what I should do, vs acceptance. Best wishes to you and your mother and sister. The story of his dental abscesses is pretty horrifying. You have my sympathies.
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If it is any help, a similar situation happened with my neighbor. He had a serious aversion to doctors and spent several weeks with chest pains then died of cardiac arrest. His wife, after a period of grief told me she had to accept his decision. He was a "big boy" who chose how he wanted to live.
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IMO anytime the brain is effected in any way, Dementia will eventually happen. Your Dad may have had problems 20 yrs ago but the brain was effected. My Mom hit her head. She was already showing signs of cognitive decline but that hit on the head made her decline faster.

Like u said, Dad has made his decision. Everyone else just has to live with it.
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Given the added info I would suspect Vascular Dementia.
If there is no POA and he does have Vascular Dementia Mom is the one that will have to make tough decisions.
If he does have Vascular Dementia he can no longer make medical decisions for himself. (Nor any other major decisions)
The other option is to obtain Guardianship and "force" treatment.
(If he does have Vascular Dementia if it were me I would prefer no treatment and opt for Hospice. )
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AlvaDeer Dec 30, 2023
I so agree with your last sentence.
This gentleman has apparently not been right for his entire marriage. He clearly didn't take care of his teeth over a lifetime it would seem. And now he is declining care. And wouldn't want an assessment. And has a wife who for SIXTY-FIVE YEARS had bowed to his wishes.

I say continue to bow to his wishes. This will go where it goes. When sepsis occurs it will likely be fast enough that considering whether or not to call in Hospice won't even be an issue.
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My feeling after reading all this at least twice, is that the sooner Dad dies, the better for him and for all the rest of the family. Perhaps rethink the wisdom of all ‘heroic measures’ possibilities, and just start grieving his death. No 'if only's, just something simple to say at the funeral. And if possible, like BarbB says, “Get your mom out of there’.
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Have you considered taking yourself and mom on an extended holiday for a couple of weeks?

Look, your dad sounds mentally ill. Neither you nor mom can do anything about that. And it appears that she's had difficulty maintaining boundaries to prevent him from damaging her financially for a long time.

Right now, it's time to divorce mom and yourself from this madness. Get out of there.
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lealonnie1 Dec 30, 2023
No kidding.
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I would say at this point it's just time to shift your thinking and focus on a future without him around.

Are his papers in order? Does Mom know where the bank accounts are? Does she have a copy of his pension papers or anything else she might need once he dies? Has she ensured she's the beneficiary on all their accounts and the house's title is held as joint tenants with rights of survivorship?

Time to get practical and leave him to his choices.
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IchibanNeko Dec 30, 2023
I agree with your point-of-view. As I stated in another reply, it's galling that Mom and I have to wait through the physical cascade failure and all its attendant nastiness, first. Forcing us to suffer watching the inevitable is just not right, especially after all the negativity he injected into our family over the years. Were I physically a cat, my ears would be back, my fur on end, and I'd be lashing my tail.

Fortunately, Mom has been fielding the finances for many years--Dad's pension and SS get deposited to an account with only immediate family female access. I'm pretty sure she has the condo title properly arranged, since she oversaw the mortgage restructuring after Dad pushed them into bankruptcy. She also signed him up with the Neptune Society, so wherever he shuffles off his mortal coil, they'll be there to handle the remains and process them to cremation. So, when all is said and done, Mom is covered for the resulting paperwork, etc.

It just...hurts my heart. He's my dad, yet my feelings mean nothing to him with regard to the pain and suffering he'll experience. My words, my love, all without worth. This is the hard part, right now. When there's no true answer to the question of why...
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Ichiban, Thanks for your responsiveness to our replies and for all the new information you provide us.
Your father, from all you tell us, almost certainly has undiagnosed dementia. However, even in the fact of that and a POA, no one can force dental care on another.
You describe your mother as being severely depleted by care of this gentleman, who has already squandered more than 200,000 if I read you right, on scams.
It would seem that your father has decided to risk sepsis.
When he is severely ill of same, do have him transported to hospital.
At that point they may attempt IV antibiotics against his will if he is (and he likely will be) demented. That may in fact lead to C-diff, and almost certainly his death.

To be honest, this is his decision. He has always been stubborn. His decisions have for decades been bad. He is about to take his poor wife down with him.
I would honor his wishes at this point. It is too late for all the guardianship and diagnosis stuff and with teeth neglected for a lifetime almost certainly then too late for that as well.
When the time comes you, your Mom, and other family should request hospice and keep your dad blessedly calm and out of pain.

I am so very sorry. Not everything can be fixed. This is sad indeed. You are not alone in seeing this in an elder. I wish your family luck.
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IchibanNeko Dec 30, 2023
AlvaDeer, thank you for your thoughts. My dad's surviving sister had much the same perspective: she told my mom (they are good friends as well as family-by-marriage) that this situation had been brewing for a number of years, and that Dad's current behavior is similar to their father's toward the end. My aunt let all of us know we have her support, and her love. When the chips are down, one finds out who the heroes are in a family...

It just leaves a sour taste in my mouth, knowing that after all the negativity he injected into our family, he gets one last poke at all of us by forcing us to watch him go through the inevitable nastiness. And with my mom having to suffer through the process, up close and personal. After what she gave and invested as his wife, the whole thing is just not right. Or as The Dude would say, mega uncool.
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Does your father have a living will? I'm curious because when your father becomes too ill to refuse any medical intervention, your mother (or his representative) can step in.

But then, if your father becomes so ill he can't refuse, why allow medical intervention and for what purpose.

Like a few others below have written, maybe he's ready to go. If that's the case, honor his decision and try to be at peace with his decision. I am sorry.
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IchibanNeko Dec 30, 2023
AFAIK, he and my mom have the same type of living will, mainly with a DNR provision. Emergency medical treatment is allowed, so when the crisis points hits, medical personnel will try their best to treat the untreatable, and then that's it.

My issue with him currently is that, after 63 years of marriage and all the negativity he put my mom through in their life together, he *still* refuses to share any type of meaningful communication with her regarding this situation. I'll grant that, perhaps, his neurotransmitters are so compromised that he's unable to articulate his thoughts--but it doesn't seem that way from our most recent conversation. I guess we've arrived at the I-don't-give-a-damn point with regards to making your wife and daughters watch you suffer until you die.

I'm coming to the conclusion that he's made his choice, and he's going to have to exist in the resulting state. I believe I have run out of both patience and sympathy for him...
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OP from your replies below it sounds like your dad has some mental health issues that have been going on for a decade or more and are just getting worse.

Unfortunately (or fortunately depending on how you look at it) people with mental health issues are allowed to make their own medical choices unless they are declared mentally incompetent. And getting someone declared incompetent is pretty difficult. Even a person with schizophrenia cannot be forced to take medications for their mental illness or for any sickness they have (though there are some states working on laws to force the mentally ill to take medication if they are a danger to themselves or others).

As for the dentists that treated your father they could have prescribed and should have prescribed antibiotics for his procedures. But I think you said one dentist said your dad refused to take the antibiotics or get them prescribed for him.

What will probably happen is your dad will get so sick he will have to go to the hospital. If he is capable of speaking he will be able to refuse or allow medical treatment. If he can't speak for himself your mom will be able to speak for him and allow medical treatment to happen.

It sounds like you are going to have a long road with your father in regards to his mental and physical health. As these things tend to keep getting worse not better. And with each problem dad has you will probably have a fight on your hands to get him to seek treatment.
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My brother died of sepsis from a tiny wound on his shin that didn't heal, and that he also kept hidden. His death was actually relatively quick, and that was even with treatment in hospital. Once hospice and a directive to no longer treat, the end came very quickly. In two weeks time, onset to death, he was gone.

You say this is your father's choice.
The only real question now is whether or not he is mentally competent to make his own decision. If he is, then it seems that he has made that decision. I am very sorry. I hope that he understands what he is doing; with his expectation of divine intervention, I suspect he does NOT. But there is little you can do about that. You honestly cannot force treatment and especially dental treatment on someone; just doesn't work. Clearly, with abscesses this severe this has been going on for a long time. I would be ready to call in hospice. He will need them.

I just heard a podcast about a woman who had rectal cancer and refused treatment, believing that all these bogus therapies would cure her. Her daughter basically begged her to get treatment. She died. There isn't a lot you can do about our right to choose. I am so terribly sorry for all involved.
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I too was wondering if antibiotics were given and if not IMO should have been. I can see not wanting to go thru root canals but he should allow them to be pulled. That will allow them to be drained. I have a feeling he may have gum disease and if so, he will need surgery because the bone needs to be scraped. Only way to get rid of the infection. I am surprised he is not sick. Gum disease is not painful because it does not effect the nerves of the tooth. It eats away the bone under the gums. Thats why loss of teeth.

Dad has his rights. He has been told what will happen.
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So two different dentist didn't prescribe antibiotics for 6 abscesses? That would be the 1st treatment, oh wait, no it wouldn't, them draining the abscesses while he was in their chair would have been the 1st thing any responsible dentist would have done.

Best of luck to your dad, maybe he is ready to leave this old world and he is going to do it his way. I say good for him.
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IchibanNeko Dec 30, 2023
Welp, everyone is entitled to an opinion. In my opinion, your remarks aren't particularly helpful. My parents' regular dentist is not an oral surgeon and couldn't have undertaken the drainage procedure. And no procedure can take place without a patient's consent.
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You do not give much info on your dad.
If dad has dementia he can no longer make important decisions for himself . (this is different than asking him if he wants a ham sandwich or soup for lunch)
The person that is POA is the one that makes decisions like this for him.
If he has not been diagnosed with dementia and this is a "new" thing, or change in his personality I would get his to his primary for a urine test. UTI can often result in personality changes and poor decision making. A stroke can also effect decision making abilities.
On the other hand if dad is cognizant and he has a lot of other medical issues he may be just "done" and if that is the case this is his choice that he is making and your next step would be to consult with the Hospice of your choice and let them manage his medical care now.
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IchibanNeko Dec 30, 2023
Yes, mea culpa on the lack of details. Dad suffered an ischemic stroke in 2002, caused by a red blood cell clump (not a clot) that passed through a cardiac PFO and blocked a cerebral artery. He suffered severe balance impairment and experienced some short- and long-term memory loss, but nothing more debilitating than that. Mom cared for him through his long recovery, wearing herself thin in the process.

A few years later, with Dad fully recovered, they sold the house my sister and I grew up in, and moved into their current condo. They had a nice nest egg from the house sale and Mom's inheritance from her mom's passing. That's when Dad's behavior turned bizarre, and he spent all that money (over $200K) on propping up a church member's store of African imports. In the middle of this situation, my sister overheard said church member discussing with his "partner" how much money they'd be able to get from our dad. Turns out the "church member" was a practiced scam artist, and he used the religious angle to con my dad but good. When my sister, my mom, and myself tried to explain what was going on to Dad, he first asked why we were "bearing false witness" against the church member. When we persisted, adamant that we were telling the truth, Dad became hostile, and refused to listen. When Mom stated that 50% of the money was legally hers, and Dad had taken it without any discussion, he responded that *he* was the head of the household and all financial resources were *his* to do with as he pleased. Mom ended up having to file joint bankruptcy, and it was a long road till they were financially clear once more. It took a court official browbeating Dad with legal chapter and verse before the gravity of the situation got through to him.

The present situation is more of the same willful obtuseness, only it's not just money on the line this time, it's what remains of his life. He's fairly healthy for his age, and could enjoy a number of years more with proper medical treatment of his dental infections. Dementia is the unanswered question in this equation, because every time Mom attempted to schedule him for the requisite medical evaluation in the past, he pulled similar passive-aggressive crap and either canceled the appointment behind her back, or simply refused to go. After a decade of trying, I think my mom is now redirecting her energy toward preserving herself.

As long as he has not been officially diagnosed with dementia, he is in control of his medical care. The oral surgeon's office told Mom that they must abide by his wishes. And as I originally posted, from his side of things, the conversation is over. Trying to browbeat him with the inevitability of a nasty hospitalization then death at this point will result in either being ignored with this smug little smirk, or a hostile response that could escalate to physical violence. So Mom and I have withdrawn from the situation to prevent further problems; that doesn't lessen our own sadness and helpless frustration, however.

Regarding hospice, pursuing that is up to my mom, since she has her own support group outside of immediate family. And no one can truly predict how his infections will advance at this time. There may come a point where he reaches screaming agony before finally allowing himself to be hospitalized. Or he may develop Ludwig's Angina and his trachea becomes occluded, ending in suffocation. (Mom signed him up for the Neptune Society, so no matter where he expires, his remains will be taken care of.)

Who knows? Maybe once all the neighbors in their large condo complex find out what he's doing, they'll overwhelm him with "You crazy, man!" and he'll change his mind by brunt of sheer numbers plus embarrassment in the neighborhood arena... Life is strange and constantly in flux.
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OP, I'm going to venture a guess here. If all of this denial of reality and stance that "God will heal me" is NEW behavior, it is possible that dad has had a stroke that has "taken out" his ability to reason and left a lot intact (this happened to my mom).

I would involve his PCP and a perhaps a psychiatrist asap.

Would you or mom consider asking the courts for emergency guardianship?
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IchibanNeko Dec 30, 2023
No, not new behavior, just worse than ever when it comes to being willfully obtuse. Dad has acted increasingly schizoid over the last decade, and this seems to be a culmination of the process.

As far as I know, there must be a valid medical diagnosis of diminished mental capacity for legal action, and my dad has torpedoed any examination Mom has attempted over the years. Same response and stubbornness we're seeing at present.
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OP I am going through something similar. It is painful to know someone is going to die because they won't accept treatment. I would just try and support his decision as hard as it will be.

He thinks god will heal him but maybe tell him sometimes god sends angels in the form of doctors and the creation of medication to do his healing for him. Then ask him why is he rejecting gods help?
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IchibanNeko Dec 30, 2023
I would make that attempt, but as I replied to Odegar23, now that he has stubbornly drawn the line, the conversation is over--any further attempts at discussion will be ignored or likely generate a hostile response.  He's essentially gone into my-way-or-the-highway mode.

I have a hope that maybe once all the neighbors in their large condo complex find out what he's doing, they'll overwhelm him with "You crazy, man!" and he'll change his mind by brunt of sheer numbers plus embarrassment in the neighborhood arena...
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Can you ‘sell’ hospice on the basis that it’s to help you (plus M and S), rather than him? The hospice people have probably met this before, and with luck could play along. Talk to them about how to frame it as ‘support for you’.
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IchibanNeko Dec 30, 2023
At this juncture, pursuing hospice is up to my mom, since she has her own support group outside of immediate family. And no one can truly predict how his infections will advance at this time. There may come a point where he reaches screaming agony before finally allowing himself to be hospitalized. Or he may develop Ludwig's Angina and his trachea becomes occluded, ending in suffocation.

Who knows? Maybe once all the neighbors in their large condo complex find out what he's doing, they'll overwhelm him with "You crazy, man!" and he'll change his mind by brunt of sheer numbers plus embarrassment in the neighborhood arena...
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Does Dad have dementia ? Is he competent ?

I’m sorry you are facing this . I had a friend , her father was too scared to get cardiac bypass surgery and chose to just let nature take its course . He died fairly young , in his early 60’s . Her Mom is 93 , a long time widow .
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Does dad suffer from dementia? It's possible that God can heal him, I guess, but very unlikely considering the degree of infection going on right now. If he's not religious in the first place, I'm wondering if he's mentally competent to make this medical decision?
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IchibanNeko Dec 30, 2023
Dementia is the unanswered question, because every time Mom has attempted to schedule him for the requisite medical evaluation, he pulls this passive-aggressive crap and either cancels the appointment behind her back, or simply refuses to go. After a decade of trying, I think my mom is redirecting her energy to preserving herself.

As long as he has not been officially diagnosed with dementia, he is in control of his medical care. The oral surgeon's office told Mom that they must abide by his wishes.
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I might guess your dad has anxiety related to the dentist. Maybe see if he would agree to a sedative pill or IV sedation? Tell him lots of people dread dental work, and that’s why they have sedation dentistry
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IchibanNeko Dec 30, 2023
If Dad has anxiety, he refuses to communicate that to anyone. And now that he has stubbornly drawn the line, the conversation is over--any further attempts at discussion will be ignored or likely generate a hostile response. He has been like this for many years, with almost schizoid behavior worsening over time.
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+1 hospice.

Choosing to refuse dental treatment will avoid treatment pain & cost, but will bring other consequences of the most severe nature.

Is there a religionious/faith leader your Dad would like to speak to about his situation & decision? Or for the wider family to speak to?

What a hard situation. Sad indeed.
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IchibanNeko Dec 29, 2023
Thanks for your reply. I don't believe my dad has any faith-based persons in his orbit at the moment. I remember that he was attending a local church prior to the pandemic; then my mom mentioned he'd stopped attending and hadn't resumed.

As for myself, I would describe myself as spiritual, but I don't follow any structured religion. Mom and I reside in Washington State, while my sister is in Oregon. I find myself alternating between sadness and an intense frustration that my dad, typically a logical and rational person (he taught math at a number of levels), is now refusing to receive reasonable medical treatment on the grounds that God will heal him. I'm certain his response to offered hospice would be similar: "I don't need that because God will heal me."

And the irony of the situation is that hospice doesn't even need to be part of the discussion, if he would just follow through with the necessary treatment...
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Does your Mom have his healthcare proxy? I don’t believe he can be forced to endure treatment but if he has a fever or could be considered mentally incompetent, you could call 911 and have him hospitalized.
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IchibanNeko Dec 29, 2023
I believe Mom does serve as his healthcare proxy officially. The depressing part is that once my dad is debilitated enough to be hospitalized, that will be the beginning of the end--he won't leave the hospital alive. In the meantime, she directly, and my sister and myself at more of a distance, will have to endure the progressive worsening of Dad's physical condition.
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I'd get hospice on board for dad immediately because I can't understand how he can bear the pain of so many abscesses in his teeth! I had one and the pain was excruciating. Hospice can offer dad comfort care and you and your mom and sister support services from a chaplain and social worker.

I'm so sorry to hear of your dad's decision and pray for a quick and painless passing for him. I hope he's open to hospice, too.
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IchibanNeko Dec 29, 2023
That's the mind-boggling aspect to this: Dad hasn't made a peep about pain, and the two teeth he lost early on in the infection process, he never said a word about to Mom, even going so far as to hide them under a placemat.

As I replied to Beatty, I'm certain he'd refuse hospice with the same illogical response that he doesn't need it, that God will heal him. And the irony of the situation is that hospice doesn't even need to be part of the discussion, if he would just follow through with the necessary treatment...

If someone had told me, even a year ago, that my rational, mathematics professor father would take such an irrational, unreasonable course of action, I would have told them they were full of çaça... The situation seems surreal at best.
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