It's said that nothing is certain in this world, except death (and taxes). Despite all our technological advances, medicine still has limitations and none of us are meant to live forever. We're all going to have to say goodbye at some point.
As much as doctors are in the business of saving lives, we are also in the business of easing suffering. Unfortunately, and all too often, I find families unprepared to deal with parting with a loved one. It's not really something they ever discussed or ever considered.
In these difficult moments, a doctor considers the realities of aggressive medical intervention. And rather than grasping at every possible way to stave of the inevitable, we must try to focus instead on accepting it. There is no "one-size-fits-all" approach. End-of-life care is fraught with uncertainty, guilt, and suboptimal communication. What I've learned is that the medical profession can and must do a better job in guiding patients towards what some might call a "good death," where suffering is alleviated and dignity preserved.
Attitudes of the physicians, the patient, and their families influence end-of-life care. In reality, we all have a right to decide our own fate. And yet in my last 13 years of practice, it remains uncommon for me to find a terminally ill or advanced elderly patient who's had this frank discussion with their family and has decidedly prepared for this unfortunate inevitability. What happens then is that the burden of deciding our fate falls on our family, whose unyielding love and devotion becomes easily clouded by guilt and false hope.
Talk about palliative care sometimes can leave patients and families feeling like the medical team is "giving up" on them. Though it may seem that way, nothing could be further from the truth. There is no perfect time for this discussion.
It always seems too soon, until it's too late… Whatever your opinion may be on end-of-life decisions, the question is always one of control, and who is going to have it over our bodies in its last moments. Why leave the burden of this choice to someone else? You know yourself best. Everyone else can only guess. Leaving these choices to your family puts them in a precarious position. One where they are asked to make vital decisions for you while being in the most stressful environment imaginable. Facing the harsh reality of our mortality can be painful enough, saying goodbye to a loved one, even more so.
Progression to end-stage disease is rarely linear and can be challenging to predict. Terminally ill patients who request that physicians make their decisions for them might get more aggressive end-of-life treatment, but this may not be in line with their own wishes. As a result, patients can end up in the intensive care unit or the emergency room days before death, even though most would rather die peacefully at home.
So, take time to reflect and make your wishes known. Caring for a loved one or parent at the end of life is easier if you've planned for it. Talk to your family and involve your doctor. Although we all see ourselves dying in old age, it's healthier to already think about it and bring it up, just in case. That way, it can be about your own personal wishes as well as the wishes of your loved ones. This will help them cope with some of the changes they may face after you're gone.
