A Difficult Conversation: Planning for Death

Physicians have a special privilege of instant intimate discussions with people. This is a privilege that many health providers do not truly appreciate because it is a daily experience for them. They sometimes take it for granted that they can ask about sex life, rashes in private places, and family problems, all in 15 minutes. Here is an uncomfortable subject not often had between a provider and patient in routine appointments: death.

Death is a difficult topic of conversation to have for both provider and patient. We each have a unique moment and unique way of dying. Despite our fears of death being a moment we cannot control, there can be some control over how we choose to die with dignity and without the fear of our wishes not to be known. How a person wishes to die and what arrangements one wants if they become gravely ill or injured are important to establish prior to death or the inability to communicate. Death is a part of life and is a natural progression. We do not usually think of our mortality until we advance in age, or until it is thrown in our face unexpectedly. This is a conversation that needs to be had between you, your family, and your doctor now — at a time when you are doing well. 

Our society is so focused on anti-aging and on cures for disease that we have become very uncomfortable with the topic of our mortality. We have so many good medical treatments for routine diseases that we think medical treatments for life threatening illnesses or even long term chronic conditions are just as good, when in fact they offer little benefit. Many of these treatments become a burden of living.

There are 4 common decisions an individual should consider when thinking about end-of-life priorities. It is best to think these through well before an urgent need to or worse, after you have died. Someone who specializes in functional medicine, could help you better understand how to make these decisions. 

1. In what circumstances do you or do you not want to be resuscitated? CPR was developed in the 1960s – and was intended to be used for situations that were accidental such as drowning or electrical shock. Since then CPR has evolved as a routine for all people who experience heart or breathing failure unless orders for restricted use were in place.

2. Do you want the use of artificial nutrition and hydration?

3. If you are a nursing home resident or ill at home, do you want to be hospitalized?

4. When is it time to shift the treatment goal from cure to hospice or comfort care only?

Subsets of those questions involve ventilator use, dialysis, and medications. These subjects should be addressed within yourself as an individual and within family unit members. Your physician can help provide guidance.

Advance Directives (AD) are documents that help protect your preferences for medical care in the event you are ever unable to communicate. A Living Will and Medical Power of Attorney are two types of AD documents. All people of all ages should have some sort of AD document in place with your files, another family member’s files and your primary care physician’s files — not in a lock box in some bank. A good doctor will encourage each of his or her patients to help protect their wishes for future medical care. Your wishes are only known if you let them be known in writing.

Each state may have different rules concerning ADs. Here are some resources to consider and review:

www.caringinfo.org Go to the Planning Ahead Tab on the home page

www.agingwithdignity.org This link has my favorite AD form called “Five Wishes.” This is a great guide and document for a complete AD.

www.mydirectives.com This link has free resources to review and download.

April 16th is National Healthcare Decision Day. Make the decision to begin, update and complete your Advance Directives so a difficult conversation does not become an impossible one.