As physicians, we are trained to save lives and heal diseases. Sometimes that includes undertaking extreme methods to keep patients alive. But, that is not always a good thing. Sadly, for some patients there is no cure for them and we are just prolonging suffering. One of the truths of life is that we must all die at some point. Many people cannot accept dying, or letting someone else, die with dignity. When death comes knocking, we cannot hold that door closed forever.
How can we let patients die with dignity?
- First and most importantly, we should know our patients’ wishes around end-of-life medical care. Patients should be encouraged to have a living will and make their wants visible and legally binding. They should also be advised to assign a healthcare proxy to make decisions on their behalf if they become unable to do so themselves.
- We must respect their wishes. Often, the temptation is there to perform life-saving procedures. But, if a patient doesn’t want it, we must abide with that.
- We need to be honest with patients. If they do not have a good chance of surviving, we must tell them. This is probably one of the hardest things a doctor must do but it is very important for the patient to possess all facts so they can make the best decisions for themselves.
- Patients should be offered options. We may give our opinion as to what we believe the best option, but they must ultimately decide the best treatment.
- Patients should be made comfortable. We should ease their pain and suffering as much as possible. Yet, we must be careful not to do anything to hasten death.
- Patients should be allowed to grieve. They should not be forced to feel strong in the face of suffering.
- Counseling services should be provided.
- Patients should be able to discuss their religious beliefs without judgment. While we may not share their same beliefs, it is important that they embrace their own beliefs, especially as it pertains to death and the afterlife. They should be permitted to prepare for the next life they believe in.
- Try to get family members involved. Often, end-of-life situations bring out the worst in people. Much fighting happens as those who love the patient think they know what is best for that person. We should try to make it clear to the family that what needs to be done is what the patient wants. We should encourage family members to be supportive of the patient’s decisions.
Death is a scary prospect to be facing. When it is apparent that it is inevitable, we must make the transition smooth allowing the patient to pass over with their dignity intact. Dying doesn’t need to be an ugly, terrifying event. Sometimes, it is a peaceful sleep into the next world. Those around the patient should strive to make it a peaceful, and not a turbulent exit.
Copyright secured by Digiprove © 2016 Linda Girgis, MD, FAAFP
Thank you for your astute and comprehensive summary, However, because we patients (and families) are novices in this end of life journey, it’s essential to ensure we understand as intended. Palliative is often interpreted as ‘there’s no hope’ ; DNR as ‘do not treat.’ http://www.bestendings.com/medical-decisions/dnr-really-mean/
As a layperson who became immersed in the nuances of end-of-life conundrums, it’s often hard to make decisions, let alone meaningfully informed ones. As Dr William Toms so eloquently writes, of one patient encounter, in Voices from the heart of medicine:
I recite the complexity of the science of it all.
She is dismayed by the excessive information I offer,
couched in pretentious “We can do this… or this…”
She thinks, but politely defers saying
“We aren’t going to do anything. I will be doing it. Alone.”
When I eventually crawl out
from behind the evidence-based wall
I’ve taken for shelter, she says
“What should I do?”
I say something about shared decision-making.
She says “Fine, but I’m asking you
‘What would you do?’ ”
http://pulsevoices.org/index.php/archive/poems/839-riding-the-rails