End of Life: So Many Questions

For years I have known the devastation that comes about when making decisions regarding death and planning for end of life care. When do you opt for treatment? When is it time to just live the rest of your life? When do we as clinicians, nurses, doctors, stop fighting to fix the problem, and resolve to lend a hand for finding peace? Throughout personal experience, encounters with families, and interactions with dying patients I have come to realize that there is no consistency in ensuring that a dying person’s wishes are conveyed and carried out. Extreme variability exists in discussions about dying and one’s end of life wishes. Talk about death is complicated, dealing with death is difficult, and when you add in factors such as multiple medical conditions that take away communication, thinking, or weaken the patient to a point of compromise, it becomes essential to start the dialogue long before the disease takes over.


In the last year or so this specific notion of dealing with death has crept into my life time and time again. First in multiple encounters of working with elderly patients with dementia, or some other illness, who did not “have their ducks in a row” so to speak, left families with critical choices on their plate. Many times a person will have laid out the basics, but when critical moments arise it is much more complicated, emotions of family member take over, not wanting to “lose” their loved one, etc. Resuscitate or don’t? Ventilator or none? Feeding tube or pneumonia? So many intricate questions crop up. Also, I have spent time talking with friends and members of my own family who don’t work in the medical field and they have dealt with similar issues. They ask for guidance from medical professionals, but find it lacking. All of these end of life determinations in the midst of an emotionally trying time. Hoping they will know the right thing to do, while keeping with the wishes of their loved one.


Wouldn’t it be nice if we talked about these decisions with the one who really is responsible for making the call long before the time comes?


The following is a guide designed to be used in conjunction with Bill Moyers’ PBS series On Our Own Terms.

http://www.pbs.org/wnet/onourownterms/community/pdf/discussionguide.pdf



Use with the series is beneficial, but the guide alone also serves as an superb resource for topics of conversation, decisions to be considered, suggestions for dealing with death, and even how to make sure our needs are thoroughly document so no confusion arises.


Initiate the conversations and listen intently. Learn how your parents, grandparents, spouses, and patients what to live out their last months and days, and how they want to die. In spite of a distressful event, you won’t be sorry.