Being Mortal

Conversations are essential, especially concerning the end of life.

doctor largeI am currently reading the book “Being Mortal – Medicine and What Matters in the End” by Atul Gawande.  Recently on PBS, Frontline chronicled Dr. Gawande and others about how the medical profession deals with the end of life with patients and their families.  You can view the feature here:

While none of us want to think about the end of our lives or those of family members, one of the main focuses of the show was on patients at the very end of life and being able to have conversations about their preferences as the end drew near.  Frontline’s documentary brought to light that for some patients, emphasis was placed on the quantity of their remaining days, rather than the quality of their last days, which can make the end of life even more difficult.  This scenario can sometimes place physicians, patients and family members at odds so it is important the patient, or family members advocating on their behalf, have a voice in end of life choices and to have medical professionals who are willing to talk with them concerning these preferences.

From the perspective of the patient, you have an obligation to speak up and share your preferences with both your family and your doctors.  Although it can be difficult to admit that your life is ending, it is important to focus on the things you can control and the things you want to accomplish in the time you have remaining.  You may be focused on the location, dying at home rather than in a hospital.  You may desire to stop the invasive and debilitating medical treatments so that you are alert and able to be in the company of your family and friends.  It may be a combination of particular comfort measures you want to have in place, or even the atmosphere of your favorite music, sounds, or personal tokens you want surrounding you.

These are not easy things to contemplate at any point in your life. However, it is easier to give consideration to them at a time when you are healthy and well.  There are steps you can take now to document your preferences for both the medical and non-medical aspects of end-of-life, as well as the other important things you want to share with your family.  Many individuals take the first step to document via their Living Will or Advance Directives documents their preferences for the use of life-sustaining measures such as artificial feeding or breathing mechanisms at the end of life. Some go a step further to also record their preferences for comfort measures, which might include soothing music, the use of massage, or pictures of loved ones surrounding them.  Documenting these types of items can help give your family guidance when assisting you during this time, especially if you are unable to communicate this directly.

In all these examples, sharing your preferences by having the critical conversations with your family during your life can help to ensure that those things which are most important to you are clearly communicated in advance of when they are needed.   Don’t assume your family will know what is most important when the time comes because emotions can easily cloud their thinking.  Instead, be proactive and communicate clearly to help them know what really matters to you.  Not all the conversations we have with our family members are of pleasant topics, but conversations such as these are critical to allow our wishes to be known and to help give our families guidance at a most important time.