Lou Anne Smoot

Lou Anne Smoot’s mother, Christina Parsons, consistently discussed her end-of-life wishes with her children and documented them in an advance directive. When at age 90 Christina chose to stop eating and cease all medication, Lou Anne supported her through the process.
Lou Anne Smoot seated on a couch smiling

“After witnessing my mother’s easy passing, I feel a sense of power and hope that I too am capable of dying the way I want.”

Lou Anne shared her story in April of 2024.

My brothers and I were raised around a bridge table. My mother, one of those aggressive players who tended to win, was a very social animal, and she and my father loved hosting games with friends at our home. After Dad passed away in the late 1990s, Mother moved from Arkansas to Tyler, Texas, to be close to me; she left many, many friends behind, but she had decided ahead of time that she was going to like Tyler and be just as social as she had always been. 

Sure enough, Mother joined a church and two different bridge groups at her retirement home. In 1999, at the age of 88, she flew to Singapore to visit my brother’s family while they were living abroad, and on an outing to Malaysia she shopped and walked the streets of Malacca with great energy. She had always been very healthy and led a senior exercise class into her late 80s. 

Her problems began with a broken hip in August 2000. She recovered very nicely at first — every chance she had to get up and walk she would take it, and usually walk farther than prescribed. But things kept going bad. Her oxygen levels were fluctuating. Her medications were making her sleep all the time. She was having hallucinations, and we couldn’t determine which medication was causing them. 

While she was in the hospital with the broken hip, her care team couldn’t get her oxygen levels stabilized, so they moved her into the ICU. I happened to walk in one day to find a throng of technicians around her bed preparing to intubate her; she was unconscious. 

Ever since I was young, my mother and my father had instructed me not only to obey them, which I did a pretty good job of doing, but also that when it was time for them to die, to let them go. They did not want to be kept alive by artificial means. Mother had always been very adamant that she did not want to simply exist through a life support system, and her advance directive had been signed and given to the hospital. But here they were putting her on life support! This made no sense. They weren’t supposed to do this without at least consulting me about it. 

I spoke up. “What are you doing? This is not what we agreed to.” 

Mother’s doctor explained that she was not getting enough oxygen on her own and was having trouble expelling carbon dioxide, and that if they could just place her on the ventilator for two or three days, that should allow her to “get over the hump” and they could then remove the machine. 

I said, “If she doesn’t ‘get over the hump’ to return to her normal life, will you take the tubes out?” 

Both the doctor and nurse looked me in the eye and said, “Yes.” I greatly respected them both. 

A few days later, they were indeed able to wean Mother off the ventilator. After she was moved out of the ICU, I learned that she had not been given a band for her wrist that would indicate her DNR order. 

Again, I brought up my concern with the doctor. He asked me to come out into the hall. He said, “I assume you want to talk to me privately.” I said, “No, I want you right here with my mother where she can hear you.” So we went back into Mother’s room. 

“Mrs. Parsons,” he explained, “your daughter gave me permission to put you on life support. The decision she made was certainly the right one at the time seeing how you have pulled through. However, something could have gone wrong, and you could have been left mentally impaired or with some other serious problem. The question is, do you want to be coded not to ever be put on life support, do you want to always be resuscitated, or do you want to leave that decision up to someone else should you need it?” 

With little hesitation, Mother replied, “I want to leave it up to my daughter.”

Thankfully, Mother didn’t need me to make that decision again. After two months in a skilled nursing facility, Mother returned to her retirement home and was back on her feet, playing bridge again and winning. Then other problems began: a blocked colon, a urinary tract infection … . We went to the hospital seven different times in less than a year and a half. Every time, Mother fought to come back. But eventually her quality of life was severely compromised. She could no longer sit up for very long, which meant she couldn’t play bridge. She no longer enjoyed food and could hardly keep any down. Each time she ate, I would hold a tray under her chin because it would almost always come right back up. She was sleeping almost all the time. She had no interest in a feeding tube. 

On November 11, 2001, I was trying to help her eat when she looked at me and said, “I don’t know why I’m doing this.” “Aren’t you hungry?” I asked. 

“No, I’m not. I’m not going to eat anything else, and I’m not going to take any more medicine.” 

My eldest son was sitting there with us. We looked at each other. “Mother, do you know what you just said?” I asked. “Yes,” she said in a clear and determined voice. “I’ve given it a great deal of thought, and this is my decision.”

I told her I would abide by her wishes. 

I reached out to both my brothers to let them know what Mom wanted. They had been raised the same way I was and assured me they would back me up in supporting her. Because Mother and I had already discussed the need for her to move from a retirement home to a skilled nursing facility, I had visited various facilities and shared my opinion of each with her. Now that I knew she needed a comfortable place to die, I spoke with the manager of one facility to be sure they would honor her wishes. They said they would. 

The day after she declared her intention to stop eating and taking medications, Mother entered the skilled nursing facility. 

When I came to visit her the second day, Mother was upset. “They tried to get me to eat,” she said. So I walked down to the nurse’s station, and I said, “I thought we had an agreement that she didn’t want to eat or take any medicine.” One of the nurses spoke up and said, “We’re required by law to ask.” I said, “Then ask once. If she says no, don’t ask her again.” And that was the last time we had problems with that. 

Over the next few days, Mother remained in bed. She seemed very serene and slept most of the time. She talked little, but when she did she was quite lucid, even carrying on short conversations with visitors. I would occasionally offer her a little water by straw, and she would say yes or no. I was amazed that she didn’t seem uncomfortable in any way. She kept assuring me that she was just fine. 

By day five her responses were mostly nods and smiles, no talking. I gave her one straw full of water, which was all she wanted. The sixth day her face lit up when I came in in the morning. She was thirsty and drank multiple straws’ worth of water. Around noon I rubbed lotion on her hands, arms, feet, legs and face. She seemed completely unresponsive. But as I prepared to leave, she piped up, “I love you.” “I love you, Mother,” I said. “You’re a great gal!”

On Sunday, November 18, the nurse and I cleaned my mother’s teeth and mouth. She talked aloud several times in response to questions. That night, one week from the day she decided to no longer eat or take any medicine, she passed away gently. She would have been 91 in six weeks. 

My mother’s mind stayed crystal clear, and she never wavered from her choice; she was able to make decisions through the last day of her life. Since then, I’ve talked openly about my own wishes with my wife and children, and believe they will follow my example by supporting me if and when I make a similar decision to stop eating and drinking. After witnessing my mother’s easy passing, I feel a sense of power and hope that I too am capable of dying the way I want.

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VICTORY: Colorado Gov. Jared Polis signed the improved End-of-Life Options Act.