I am so grateful to Dr. Atul Gawande's piece here acknowledging that end of life discussions are hard and his admission that he failed Sarah, a 35 year old patient of his, and her family when he neglected to have this discussion with her before she died.
When I worked as a Palliative Care Clinical Nurse Specialist at a local hospital, I was hired to have end-of-life discussions with patients who were in an acute crisis in the hospital. These were incredibly difficult conversations.
Imagine being told that you are dying. That alone is profoundly painful news to take in. Then on top of it, to be told this news while you are in a crisis. I would assimilate that to my spouse asking for a divorce while I'm in the hospital rather than talking about it before then or after the crisis has resolved. And on top of it? Here I was, a total stranger to this person, giving them the news that they are dying. Imagine a total stranger telling you that your spouse is divorcing you. Wouldn't you rather hear that from your spouse? I have been seeing the same primary care doctor for over 10 years. Although I only see him in the context of medical problems, we have established a level of trust that cannot easily be replaced. I would *much* rather have him break bad news to me than someone who doesn't share the history that we have with one another.
I think this video does a wonderful job at explaining what these so called "death panel" conversations are really about and the challenges that must be overcome in order to have them.