The blessing of a good death

This year isn’t even a month old yet, and my family and friends have been struck with the loss of loved ones. It’s never easy, and one can never be truly prepared for such a life-changing event. One day they’re there, and the next they’re gone.

But how can one have what they call a “good death?” One void of distress and suffering for the patient, their family and their caregivers; where a patient’s wishes are met, and if you are lucky, one where there is time to say goodbye.

It’s never an easy conversation — how to talk to your patients about advance care planning. No one wants to talk about the end. As physicians our primary mission is to prolong life. To have this discussion during the best of times is already difficult, even more so when a patient is critically ill and can no longer make his wishes known.

As physicians we do everything we can — placing breathing tubes, using a mechanical ventilator, various medications running through different IV lines and tubes, and doing CPR if necessary — all to give patients the best chance of survival.

PHOTOGRAPH COURTESY OF unsplash/aaron blanco

If given the choice, however, many older adults and those with serious medical illnesses would decline such treatments. If care and support to relieve any pain or distress were available, they would rather remain comfortable and not endure anything invasive.

The only way to know for sure though is to ask in advance of an emergency. Having these conversations well before they are necessary allows the patient to take control and have a say in how it ends. It relieves their family of having to make difficult decisions. By knowing ahead of time, physicians can then prescribe medical care that is in line with what the patient wants, or doesn’t want.

When discussing this situation with the patient and their family, pause and allow them to process this information, to express their emotions, and to ask questions.

Offer the patient three decision options:

1. Time to think about it if they’re not sure what to do. Have another discussion at a later time, but don’t wait too long.

2. “Do whatever you have to do to try to keep me alive.” If this is the patient’s decision, verify that they want to be placed on a ventilator in the ICU if their breathing worsens and that CPR will be done if their heart stops beating.

3. “I would never want to be on one of those machines.” Confirm that the patient does not want any
life-saving measures such an intubation, mechanical ventilation, dialysis, or CPR.

PHOTOGRAPH COURTESY OF pexels/tima miroshnichenko
Forgive yourself, bury the grudges, reconnect with lost friends, strengthen relationships, and spend as much time as you can with your loved ones.

Physicians may be surprised that patients are often relieved to be having this conversation because they are already thinking about these issues but are unable to express themselves. Whatever the patient prefers, document it in the medical record and make an official document, with copies for both you and your patient. Also let your patient know that they can change their mind at any moment.

We all have to go some time, but we never know when that moment will be. While you continue to take care of your health, be prepared and make your wishes known.

And furthermore, go on vacation and take that trip, finish that book, wear the fancy outfit. Forgive yourself, bury the grudges, reconnect with lost friends, strengthen relationships, and spend as much time as you can with your loved ones. Someone recently said that when it is our time, we should no longer have dreams, only memories. May we all be blessed with the grace of a good death in the end.

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