Saturday, January 30, 2010

DIFFICULT DECISIONS - AN UNPLEASANT TOPIC

It is widely believed that one of the most unique characteristics that distinguishes the human race is the knowledge of our own mortality.  We're all going to die and no matter how well we deny it death is the "gorilla in the room" of each of our lives.

It's one thing to take responsibility for our own end-of-life decisions, and we all must, but it is a more difficult task to take responsibility for someone else's.  Many of us have found or will find ourselves in that very situation. When a loved one is seriously ill or incapacitated there are choices and decisions to make.  In the midst of sorrow and grief we are thrust into the seemingly  impossible end of life decisions.

There are so many factors that come together ranging from the emotional to the practical to the ethical.  In many cases there is no absolute right or wrong but only what is right for you , your loved one and your family.

What would the patient want?


First we have to deal with the sadness at the immanent loss of a loved one.  Then we have to deal with the enormity of the decisions we are being asked to make.  This is an overwhelming sense of responsibility.

Comfort, love and the minimization of pain are at the top of the list of concerns.  How much extraordinary medical measures are we willing to have performed and to what benefit.  What is the patient's "quality of life"?  Are we sacrificing comfort for negligible gain?

Beyond "extraordinary" measures, how much "ordinary" measures are we willing to have withheld?   There can be questions of feeding tubes, antibiotics, IV nutrition and even fluids.  These are questions that need to be fully discussed with the doctor and family members.  There are differing opinions as to what is needed for the most comfortable passing.

Why the Republican "death panel" myth is cruel


During the course of the Healthcare Reform debates of the past year one of the most irresponsible false issues raised was the allegations of so called "death panels" to force end of life decisions.  This is not only nonsense but hurtful.  The truth is that this portion of the bill dealt with insurance paying for the doctor consultation visit regarding end of life decisions.  It is imperative that we discuss these decisions with medical professionals in order to make the most informed, humane decisions.  The doctors do not make these decisions.  They offer the choices and discuss the prognosis with the loved one who is responsible for making the decisions.  It is criminal to think that anyone should be asked to make life's most important decisions without the benefit of being as well informed as possible.

Tough decisions are easier in good times ....


Don't wait until the dreaded time arrives.  Have discussions with loved ones while they are well and able to make their wishes known.  Discuss your own end of life philosophy and wishes with your loved ones to spare them from having to wonder.  Consult a legal professional, fill out healthcare proxies and make a living will.  No one wants to deny his own immortality but doing so now will alleviate some stress later.

With decisions made you can spend your energy and focus on the patient.  Give your comfort, love and support.  I held the hand of a loved one and spoke to him and comforted him while he passed from this life. I know this helped to make his final moments peaceful for him but also made his passing easier for me to accept as well.

Death is one of the few experiences that we all have in common and yet it is one of the most difficult and least discussed topics in our modern civilization.




1 comment:

  1. Cheryl DeLaVallierreJanuary 30, 2010 at 9:29 PM

    Chris, I have to say you covered all the bases! This is such an important topic and so many people put off discussing it because it is very painful. The truth is, once the wishes of the dieing person are made known to the loved ones, who are caring for that person, and in writing, I would like to think it does make the passing from this life into the next, a more peaceful time, for all involved. However,,,, I have dealt with those who irregardless of their loved ones wishes, just can't seem to let go. They are holding on to every moment, using all necessary medical means in hopes that the end is prolonged just a little while longer. Selfishly, sometimes it's because financial and personal matters have not been resolved. Sad, isn't it!!! Let our loved ones die with dignity, respect their wishes and as Chris did, sit, hold their hand and let them know it's OK, to let them go. I sat with someone at Hospice not to very long ago. A very special woman by the name of MaryAlice. She had been ready to die for months and didn't want any medical means that were unnecessary to keep her alive, just those that would keep her comfortable. Her family knew this in advance and the wheels were in motion so that when her time came, they would be able to make their mothers last few days with them, as comfortable as possible, but not interfere with her wishes. They were ready to physically let her go!! As I sat with MaryAlice one day, she was not really coherent but I looked at her as I held her hand and I said "MaryAlice when you see GOD would you put in a good word for me?" Her response was "Yup" ... it was a word we shared everyday. She had not spoken a word in days, not even to her family, and yet she managed to utter that one word to me "Yup"... I knew then, she would be fine and so would I. <3

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