We live in society where there is a little white pill to cure every ill. There exist pills to make us sleep, some to wake us up, some to slow us down and some to speed us up. As doctors, our mission is to save and prolong lives. As caregivers, the goal is also to prolong lives. But, sometimes we need to say goodbye.
End-of-life care is a major money drain in our current healthcare system. Sure those dying need proper medical care. But, often what is provided instead is futile medical care. Not only is this care costly and useless, but often it just protracts suffering and pain.
As a doctor, one of the most difficult tasks I face is initiating discussions about a patient’s final wants and wishes. Doctors want to heal but sometimes it just is not possible. We wish to give hope but not infrequently it is in vain. For this reason, it is imperative that doctors discuss end-of-life issues long before the patient suffers a terminal illness. In fact, most adults should draw up a living will so that their desires are known. Accidents happen every day. No one knows when they will wind up facing a life-threatening crisis or even an unsalvagable one. Unless there is a living will, the medical team will do everything to prolong your life. That is why we see in the news stories of patients who ended up in vegetative states. Death is one thing but to spend years in such a condition is worse for many.
Decisions need to be made that when healthcare is futile, there must be a time to stop. Heroic measures in the face of brain damage from prolonged hypoxia is not care at all. Rather it is extending the inevitable, creating more suffering for the patient, and placing a greater burden on the family. It is a far harder decision to make to “pull the plug” than to just let the patient die gracefully.
Doctors must become comfortable initiating these talks with patients and their family members. And foremost before everyone should be the patient’s wishes. Doctors like to give hope. But, we are also expected to give honesty. When no good outcome is possible, we need to be able to communicate this effectively. And not only doctors. This applies to the whole healthcare team that is responsible for the care of the given patient.
And the loved ones need to be open to these conversation. It is very hard not to make decisions based on love and emotion. If possible, a healthcare proxy should be named. This is one who safeguards the patient’s wants, even in the face of disagreement. Once a proxy is established, other members must step aside and not complicate the decision-making process. All to often, a person’s last moments in life end up in a family feud. Input is important from everyone. But, the legal person should be allowed to carry out their role. It surely is not easy for them.
As people live to later and later ages in the US, we will see these end-of-life issues more commonly. Sometimes the best medicine is no medicine at all. Sometimes, we just need to allow our loved ones to quietly pass on and say our goodbyes.
Copyright secured by Digiprove © 2015 Linda Girgis, MD, FAAFP
Great article and a must read. Congratulations! Patients do quikcly disseminate what’s valid vs. what’s harmful or wrong/irrelevant. Social Media is a great help in healthcare, for patients at least. I hope to see more medical professionals using it as a good education and patient support tool.
Great post, so important to have these conversations. Thank you for the information.