Talking Often, and Calmly, About Dying

This week, end-of-life care discussions joined the political debate over health care reform. What started out as legislative proposals to finance optional end-of-life care consultations between doctors and patients morphed into governmental bodies (so-called "death panels") that would decide which dying patients would and would not receive care based on cost-cutting measures. False assertions and rumors resulted in debates so ferocious that even well-seasoned health care advocates were taken aback.

As someone who has written an entire book about the difficulties of caring well for the dying, I find all the fury aimed at halting support of end-of-life care discussions more than a little ironic.  Why? Because the truth is that most of us need all the help we can get to start these difficult conversations. The truth is that we never talk or even want to think about talking about dying because we are afraid of dashing the hopes of our loved ones or our patients. The truth is that we fear -- even abhor -- these discussions because we believe that by talking about dying we are giving up.

Yet all of those imagined fears could not be farther from the reality of end-of-life care discussions. At least according to some of the best research on the impact of these conversations on patients and their loved ones.

In this week's "Doctor and Patient" column, I speak with Dr. Holly Prigerson, one of the country's leading researchers on end-of-life care discussions, and ask her about the significant and enduring effects of these conversations on patients and their families. 

Have you, as a patient, friend, family member or doctor, participated in end-of-life care discussions? Were they difficult? Did they make a difference? And do you believe they should be supported in legislative proposals for health care reform?

Please leave your comments below or in Tara Parker-Pope's "Well" blog.

Comments

[SYED T S HASSAN]

Dying is part of living processes. From a few experiences it's better to talk than to balk. A feeling of emotional closure and satisfaction ensures after such "difficult" heart-to-heart talks. Conservation of dying dignity solicits conversation on end-of-living reality. Syed TS Hassan, 17 Sept 2009, Malaysia.

[hannah]

I realized recently that one of my Dad's doctors has been subtlety laying the groundwork for this discussion for several years. Sometimes the words were jolting and uncomfortable, but I know one day this discussion will have an immediacy to it and starting the dialogue now gives us something to lean on in the future. I can't think of much that could be more important in medicine.

By the time you reach the point of making end of life decisions, if you haven't thought about it and discussed it, at length, it's too late in some respects. People are scared and thinking in terms of prolonging life rather than realizing they are merely delaying death. Thoughtful discussion would allow people to be truly empowered in their decision making, rather than reactionary. It would promote the opportunity for ineffective interventional treatment to be stopped while meaningful reflection and closure for the dying person and their families are still possible.

[Sara Shollenberger RRT]

As a respiratory therapist,I can attest that physicians are often vauge to say the least,at the "bad news"conversation.Many times I have been the one to have this discussion with family members, often in the emergency room.I learned to do this as a young therapist, because no one else was, to prevent suffering and frankly to reduce my work load and my moral distress.I do it now because I know it's the right thing to do.I have no problem with setting up life support if it gives the family time to deal with a loved one's terminal situation. Thank You Dr. Chen for Final Exam!!

[Pauline]

Thank you, Sara, for your comment and for your work!