End-of-Life Choice, Palliative Care and Counseling

Notion of ‘good death’ evolvesby Jay

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By Dr. John Sergent
The Tennessean
April 5, 2012

I graduated from medical school in 1966. Cardiopulmonary resuscitation (CPR) was brand-new, and my fellow interns and I were like soldiers ready to do battle with the enemy, and the enemy was death. We did CPR on almost everyone in those days, and we were pretty good at it. I remember the tremendous sense of satisfaction I would have when a heart rhythm would be restored and the patient would be wheeled out to the ICU. Death was always the enemy and we were the warriors.

At the same time that our CPR techniques were improving, we were also getting better at keeping people alive with feeding tubes, better ventilators and so forth. Gradually, however, we came to realize that virtually none of our seriously ill patients were leaving the hospital after CPR. We could get a rhythm back, only to watch the patient languish in the ICU for days or weeks, with all the anguish that produces in families, before finally dying.

Gradually, we began to see the problem our technology had created. Prior to the middle of the 20th century, people usually died at home, surrounded by family, and death was seen not just as a physical event but it had a deep spiritual context. As the majority of deaths moved from the home to the hospital, often in the ICU, death increasingly took on a purely physiological context, with little attention to everything else it represents. This spawned a number of books, especially the pioneering work of Elizabeth Kubler-Ross, who documented the stages of grief in dying patients. The hospice movement soon followed as people began openly discussing the components of a good death.

In 1997 the Institute of Medicine weighed in with this definition of the good death: “A decent or good death is one that is: free from avoidable distress and suffering for patients, families, and caregivers; in general accord with patients’ families’ wishes; and reasonably consistent with clinical, cultural, and ethical standards.”

We are fortunate in Nashville to have many individuals and organizations available to help people plan for their own end-of-life care. Certainly everyone should execute a living will and a durable power of attorney for health care, but that is only the first step. The critical next step is to have an honest conversation with your family, your physicians, and others you care about, so that they know exactly the point at which your quality of life outweighs simply extending the dying process.

To facilitate these discussions, The Gift Initiative was formed by Alive Hospice in collaboration with hospitals and organizations in our community, all of whom recognize that planning in advance can guide decisions consistent with our personal values. The Gift Initiative is offering two panel discussions, “Conversations About End-of-Life Care,” on April 10 at Montgomery Bell Academy and on April 24 at Murfreesboro Center of the Arts. For more information and to RSVP, contact Pam Brown at pbrown@alivehospice.org.