Wednesday, November 15, 2006

End of Life Issues - Are we really prepared?

"The Last Word on the Last Breath" by Jan Hoffman, The New York Times, Oct. 10, 2006

The article was quite interesting and sadly all too true. In today's world it seems that no one wishes to discuss death or dying until often it is too late. Healthcare personnel are often the ones who bear the burden of society's silence on the issue of death. It isn't until attention is brought to the subject by the media as in the Nancy Cruzan case do we find ourselves thinking, "Perhaps I should write a will or at least let my wishes be known regarding my own death." But how many of us really carry out our intentions and have a will or advance directives written. I don't know if it is fear of dying or really our excuse of "being too busy" or "I'm healthy, nothing is going to happen".

Whatever it is, by not putting our wishes down in writing, we are indeed putting the burden of resuscitative measures on our loved ones and our healthcare providers. I am just as guilty as another and have not drawn up a will or advance directives because until now I really never gave it much thought. I know my husband and I have communicated our wishes to each other, but we haven't put them in writing.

As mentioned in the article, CPR was designed for use in sudden cardiac arrest. It was seen as a tool which provides one a chance for survival. It is taught as part of the American Heart Associations "Chain of Survival." It indeed can be very effective for sudden cardiac arrest and may provide a "second chance" for someone. However, when a person is gravely ill and the outcome is bleak, is it truly worth a "second chance" if all that means is more suffering. I really don't believe so. We need to be able to say enough. Let's just keep my loved one comfortable for how ever much time they have left. Often the family is trying to deal with their loved ones' illness and may not be able to provide an answer regarding DNR or CPR issues. Both families and patients need time to deal with the idea of death. I remember Dr. Elisabeth Kulber-Ross's books on Death and Dying and the stages of death a person and family go through on their journey - denial, anger, bargaining, depression and finally acceptance. I believe that where a person or family is on their journey will have an impact on their decision or lack of decision regarding a DNR issues.

Sadly without POLST (Physician Orders for Life Sustaining Treatment), Advance Directives, Living Wills, etc., if you should have a cardiac arrest while hospitalized, you will receive the latest that medicine has to offer related to resuscitative measures. Healthcare providers have no choice but to respond because to not respond could mean an expensive malpractice lawsuit. Hence, individuals really need to rethink about their view of how to deal with a life threatening illness and not leave issues of "what to do if… happens" to their family or loved ones. As stated earlier, I haven't filled out any Advance Directives or Living Will or even made a will, but as I near the half century mark, I see the need to have an open conversation with my children and husband and put my wishes in writing. Because remember, without anything in writing, treatment will be given no matter what the outcome. I would rather die at home with my family at my side than in a hospital bed connected to machines.

Article can be viewed at

1 comment:

editor, Sustainability Southeast said...

A thoughtful post -- thanks.

From what I can see, our culture has no coherent concept of "quality of life". Thus it makes sense to me (sadly) that we have no coherent way to think about the quality of the end of life. For many of us, our concept of death seems like a puzzle piece that doesn't really fit anywhere.

For me, personally, thinking in terms of quality of life helps me to make sense of this and other vexing issues, such as health care, social justice, our environment and pollution, sometimes even politics.

So, thanks for offering practical suggestions to address our quality of life.