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Death: Let's Talk About It

Posted Jan 14 2009 7:45pm

Death, despite its inevitability, is often not spoken about, let alone planned for. To get people talking about this subject, the sister-in-law of a young mother who died of a brain tumor has initiated a simple project that consists of five key questions regarding end-of-life preferences. She asked medical bloggers to spread the word about Engage With Grace via the Internet just prior to Thanksgiving, with the hope that as families gathered for turkey and pumpkin pie, they would also make the opportunity to talk about death. Maudlin, you say? Considerate would be a better word. Don’t we owe it to ourselves, and to those who might have the responsibility of making decisions for us as we near the end of our days, to make our wishes known?

It is not a complicated set of questions. They are: Given the choice, would you prefer to die at home or in a hospital? Can a loved one accurately say how you’d like to be treated in the case of a terminal illness? Have you appointed someone to advocate for you as the end nears? Have you written a living will, arranged a medical power of attorney or completed an advanced directive? The fifth question asks where you might fall on a scale that extends from ‘no treatment whatsoever’ to ‘make every possible effort, including unproven treatments.’

As I scanned responses to the request, I read one from a physician who believes that stating one’s desires might be a wasted effort because one’s wants would more than likely change, depending upon the circumstances surrounding one’s end of life. A nurse answered his comments by admitting that, yes, preferences could change over the course of a lifetime but the importance of the questions and answers being discussed at all far outweighs that possibility. Planting a seed for thought is a step in the right direction to getting us to consider these questions and to make decisions accordingly.

Physicians and nurses should be open to assisting patients in making these decisions, if their advice is sought. More to the point, perhaps this is a conversation that should be initiated by the physician or nurse during routine visits. Why wait for the patient to think of it on his own? Before we reach senior status, when we are feeling hale and hearty, such details are easily pushed aside as something we’ll need to handle much farther down the road. Along with ‘do you smoke, drink, exercise and wear your seatbelt,’ why not add, ‘have you made your wishes known regarding your medical treatment in a situation where you are unable to speak for yourself?’

Your thoughts on this subject would be appreciated.

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