A child who has discussed these issues with her parents, and makes the right decisions in accordance with her parents' wishes, still faces guilt and indecision when the end comes and it's time to let go. If you combine that with unsupportive and accusatory siblings, that guilt and second-guessing can continue for years after the parent dies.

It's important to make sure that all children are involved in the discussion, especially if they don't agree with each other and the parent, and are hostile to any decision to forego care. Communication is hard, and distances are long, and it's far too easy not to have these discussions with the dying relative far away. It takes effort and will to make these discussions happen, but they are necessary.

I lost my mother-in-law earlier this year to leukemia, and ultimately she made the choice to forego care. My husband and his two siblings provided in-home hospice care for their mother, because she wouldn't even allow any nurses or doctors in her home. This was a huge commitment, in time and also emotionally, since we basically became nurses ourselves and had to learn to perform many procedures. If we hadn't be in complete agreement and totally aware of what we were signing up for, it could have created a family rift. Instead, it brought us closer together.

My grand-father is in a similar situation. After years of dementia, he was diagnosed today with pneumonia after he stopped swallowing last week and reacting to people some weeks earlier. He'll die soon, but he'll die at home, where he was nursed by his loved ones until the end.

I'm glad he won't die in a hospital like my other grand-father, who died from cancer after many chemotherapies. My grandmother never gave up hope and it hit her hard when he finally died. I wished he could have died at home, even if that meant his life was some months shorter.

“It has become, in my view, a bit too trendy to regard the acceptance of death as something tantamount to intrinsic dignity,” he wrote in his 1985 essay. “Of course I agree with the preacher of Ecclesiastes that there is a time to love and a time to die—and when my skein runs out I hope to face the end calmly and in my own way. For most situations, however, I prefer the more martial view that death is the ultimate enemy—and I find nothing reproachable in those who rage mightily against the dying of the light.” (“The Median Isn’t the Message”)

A personal hero of mine, Philip Berrigan refused most treatment on his liver cancer and died within a year of diagnosis. My mother 'got martial' in Gould's terms and fought doctors and death until she got her lung cancer taken care of. She is on the 'long tail' of the curve.

Impossible to know how one would react. I can see the reasons in both cases and respect both decisions.

How does one know that one's "skein has run out"? (what a nice turn of phrase)