End-of-Life Choice, Palliative Care and Counseling

End-of-Life Consultation and Changing Medicineby Barbara

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The Summer 2010 edition of the Compassion & Choices Magazine features our End-of-Life Consultation Service, the oldest and most comprehensive program in the nation offering candid, authoritative information and non-judgmental support to individuals who want to meet death in comfort and control.

Our Consultation program began seventeen years ago, in 1993. Back then common wisdom said anyone offering concrete information about how to achieve a peaceful and humane death would soon be prosecuted and jailed for assisting a suicide.  Today’s Compassion & Choices Consultation staff and volunteers stand in a long line of courageous, compassionate people who put themselves and their very freedom on the line to offer choices to those suffering beyond tolerance.

Our reach is vast and our impact is great. From coast to coast and border to border patients empowered by the information and support from us approach their doctors and receive what they need. Sometimes it’s better treatment for distressing symptoms. Sometimes it’s relief from painful and burdensome treatments that were neither extending their lives life nor improving its quality. Sometimes it’s discontinuation of the thing that prolongs the dying process, like a cardiac pacemaker or the cortisone that checks brain swelling. Sometimes it is a prescription for medication, accumulated over several months until a life-ending dose is obtained in hand.  Always, always, there are options — transparent when possible, discrete when necessary.

Each time a physician participates, she learns it’s OK to speak frankly with dying patients. Each time a patient becomes empowered with choices, his medical team and family witness the lifting of anxiety and the psychological transformation that replaces fear with freedom to enjoy life again.

From the beginning we never saw our service separate from, or in conflict with, hospice and palliative medicine. Our goal is always to help clients get medicine to work for instead of against their deepest wishes.  And in the process, hospice by hospice, town by town, clinic by clinic, doctor by doctor, nurse by nurse, slowly but undeniably, medicine is changing.  Seventeen years ago it was uncommon for a physician to agree to write a barbiturate prescription, with the understanding of its intended purpose if suffering became unbearable. Now physicians do write these prescriptions, knowing understand their patient may not even use it, but just wants to have it for peace of mind.

Our own End-of-Life Consultation program models that practice. We’ve been urging medicine to do right by dying patients and demonstrating how it’s done for seventeen years. People will probably always look to us for information and support to begin their decision-making process. But in decades to come, we know we will not be the primary providers who meet the need. Medicine will rise to the challenge and will deliver not only cures for disease, but also palliative support, choice, control, empowerment and spiritual meaning when cure is not to be had.