End-of-Life Choice, Palliative Care and Counseling

Posts TaggedConversation

Advance Care Planning Can Ease Difficult Decisions

by David Wahlberg
Wisconsin State Journal
December 10, 2012

When patients near the end of life, many doctors say there’s nothing more they can do.

But “there is so much we can do for people at the end of life,” said Dr. Jim Cleary, UW Health’s director of palliative care.

Doctors can provide pain relief, comfort care and guidance to families, Cleary said.

“For a physician to say, ‘There is nothing else I can do,’ is really, I think, a neglect of their physician duties.”

Cleary’s comments are from “Consider the Conversation: A Documentary on a Taboo Subject.” The 2011 film by two Wisconsin men has sparked an initiative to expand advance care planning around the state.

In the first phase of the effort, nurses, social workers and clergy at Madison’s health systems will begin offering discussions about end-of-life decisions to select groups of patients in March. Broader outreach is planned in 2014.

Instead of merely asking patients if they have living wills or health care power of attorney documents, hospitals and clinics will offer discussions about a variety of questions — from whether to resuscitate and ventilate to what kind of people, music and lighting patients want to be surrounded by when they approach death. More

10 Tips on Dying With Dignity

by Laurel Lewis
December 5, 2012

These tips come from my experience of being with hundreds of people as they have died and with the thousands of family members who have witnessed this event. Consider using these tips for dying well … and for living well!

10. Talk about what you do and don’t want.

Tell your family, friends and doctors how you want to be treated and what kind of treatments you want or don’t want! Consider a living will or other advance directives so that your wishes will be known prior to end of life choices. Consider your needs: physical, emotional and spiritual because they all impact your final days.

9. Have a life review. Recall significant and meaningful events .

Share your stories either verbally or written with your loved ones, in a journal or on tape. As you do this forgive yourself and others for everything! Let go of judgments. Judging people and events take up precious energy that could be spent loving instead. Release the judgments and allow yourself to be fully present to what is in your life right now.

8. Express gratitude daily – for something, anything!

This will help move you from the context of small self who is dying to connect with the bigger part of Life that is surrounding us always. Expressing gratitude creates a positive shift in our mental state, which in turn has positive physical benefits. More

Early End-of-Life Talks Tied to Less Aggressive Care

by Genevra Pittman
Reuters Health
November 12, 2012

Terminally ill cancer patients are less likely to get aggressive end-of-life treatment, such as chemotherapy in the last two weeks of life, when they talk with their doctors early on about how they want to die, according to a new study.

Treatment aimed at keeping those patients alive at the end is often expensive and may not improve patients’ quality of life or comfort. Such therapies usually involve more time in the hospital rather than at home or in hospice care.

“Aggressive care at the end of life for individual patients isn’t necessarily bad, it’s just that most patients who recognize they’re dying don’t want to receive that kind of care,” said Dr. Jennifer Mack, the study’s lead author from the Dana-Farber Cancer Institute in Boston. More

Hard Decisions in the I.C.U.

by Paula Span
The New York Times
October 24, 2012

Your relative has spent five days in a hospital intensive care unit, unable to breathe without a ventilator and incapable of making her own medical decisions. Because she appointed you her health care proxy, or simply because you’re her closest relative, the choices about treatments — trying them or stopping them — fall to you.

It’s not a hypothetical situation: One-fourth of elderly people die in an I.C.U. A patient in intensive care on a ventilator probably requires a feeding tube, a catheter, various IV lines. Perhaps her doctors are suggesting dialysis or recommending surgery. There are many choices to be made.

To act as her surrogate is a daunting proposition. “It’s incredibly intense to not only be confronted with loved ones at death’s door, but to have to make treatment decisions you hope are in their best interests — and sometimes you’re not sure,” said Douglas White, a bioethicist at the University of Pittsburgh Medical Center who has studied end-of-life decision-making for years.

Discussions about the end of life, when they happen at all, often focus on what would happen if someone becomes irreversibly comatose or faces a terminal disease. But the victim of a severe stroke, for instance, may remain extremely impaired, physically and mentally, and institutionalized for the rest of her life — yet still be semiconscious.

“Is this a state in which a person would want to be kept alive?” Dr. White said. “It’s a tough question to answer.” More

The Facts on End-of-Life Care Programs

by Terri Schmidt
Milwaukee Journal Sentinel
October 23, 2012

In 2001, my frail 94-year-old grandmother – a lifelong Wisconsinite – died in a way consistent with her wishes. But it wasn’t easy. It required relentless advocacy by her daughter, who signed “Do Not Resuscitate” paperwork three separate times in one week after my grandmother fell and was taken to the hospital with a serious brain injury.

My grandmother’s loving Brookfield foster home wanted her back with hospice care. Her daughter needed to sign paperwork to confirm her desire to avoid hospitalization and die at home – first at the hospital, then just for the ambulance ride home and again for the hospice admission.

All of this could have been avoided if a system had been in place that made it possible for health professionals to follow a seriously ill patient’s wishes when transferred from one facility to another. With a system in place, patients with advanced illness might have thoughtful conversations with doctors and family about treatments they do or do not want, complete advance directives and appoint trusted loved ones as their health care decision-makers when they cannot speak for themselves. More