End-of-Life Choice, Palliative Care and Counseling

Column: Making end-of-life decisionsby Jay


By Kathryn B. Brown
The Daily Astorian
June 19, 2012

I have seen many people die in hospitals.

As a hospital nurse on a cancer and AIDS unit, I got to know many patients over time, as they came in for surgery, chemotherapy and radiation therapy.

Some of them fought hard until the end, pursuing every treatment, and died angrily and reluctantly. Some of them were able to come to terms with their illness, were content with comfort care, and died peacefully.

A hundred years ago, dying at home was the norm. Now, most Americans die in hospitals, so few of us have had the experience of being with someone dying at home.

People who have had the experience of spending time with a dying person – someone who is at peace and not in pain – usually describe it as deeply meaningful and life-affirming. Hospice nurses and volunteers know that dying people need emotional and spiritual support, compassion and pain control above all. Helping manage the symptoms of disease and focusing on comfort and dignity are the hallmarks of hospice care.

The blessing and the curse of modern medicine is that people are living longer than ever. The average lifespan for Americans is about 80 years. Heart disease, cancer and lung disease account for most deaths later in life. All can cause significant disability and pain in their later stages, and treatments for these diseases can cause even more suffering.

Yet, our health care system in general is not skilled at knowing when to stop aggressive and futile treatments to allow a peaceful death. Health care providers want to do all they can to help their patients – the primary goal is usually to keep patients alive. Physicians and hospitals are paid for providing treatments, so there is no financial incentive to stop treatment and recommend hospice care. Most people, when faced with a serious illness, have faith that their physicians will be able to cure them or at least delay death for a long time. Family and friends don’t want to lose their loved one, and so tend to encourage the fight against the disease, and discourage “giving up.”

But, sometimes “giving up” the fight means gaining time: time to do the things that are most important to a person and time to spend with loved ones.

In his blog post, “How Doctors Die,” – http://tinyurl.com/87dcttc – physician Ken Murray describes cases where physicians have been diagnosed with serious diseases and have decided not to seek treatment. They have seen the suffering that aggressive – and ultimately unsuccessful – treatment can cause. They choose to live their remaining days as fully as possible, avoid hospitalizations and die a natural death. It’s a thought-provoking essay about quality of life, and one everyone would benefit from reading.

Few of us fully acknowledge it, but death is a part of life. When we think about our own mortality, most of us hope for a long, full life with a swift, painless death – ideally in our sleep. The reality is, many of us will develop a fatal condition later in life.

Most people prefer to avoid thoughts of disability and death, and so don’t plan for it – but the practical thing for adults to do is to prepare for the inevitability of death by buying disability and life insurance, estate planning, creating an advance directive, filling out Physician Orders for Life Sustaining Treatment (POLST) forms and discussing end-of-life wishes with loved ones.