Early in our medical training, we both squirmed when we discussed death with our patients.
We'd stumble through the conversation at the end of a long visit: Mrs. Jones, if your heart stops beating, what do you want us to do? Mr. Clark, if you stop breathing, do you want us to attach you to a machine? We didn't know how to begin a real conversation with our patients, and our patients didn't always know how to talk to us about their wishes.
It is not easy to think about the end of life. We're not culturally wired for it. But it is one of the most important conversations you can have, if not for you, then for the people you love. If you don't have these conversations now, then your loved ones are left guessing as to what to do during a time of incredible stress and uncertainty.
April 16 is designated National Health Care Decisions Day. It is a day to think about questions such as who will speak about your health care choices if you cannot? Who will tell your doctors whether to put a tube down your throat, shock your heart, perform surgery, or focus primarily on keeping you comfortable?
This may seem overwhelming, or really dreary, or like a big fat death-panel-laden conspiracy. It's not. You have an opportunity to say what you would want "if " and to empower your family to know how to care for you in times of chaos.
You have an opportunity to designate a medical durable power of attorney (aka "DPOA"), the person who can legally represent your medical choices when you cannot speak for yourself. You also have the opportunity to write a living will to share with your loved ones and your doctors. Your living will describes what type of care you want when you are terminally ill or have a condition that won't get better (like dementia). Whether you want all-out resuscitation or to 'let nature take its course' or something in between, these documents help your choices be honored. Together the DPOA and living will make up what we call an "advanced directive."
While 71 percent of Americans have thought about their end of life preferences, only 29 percent of people have a living will in place. There are many ways to start this conversation. Take the people you want to be your DPOA out to coffee. Talk about all kinds of medical situations - whether from your own experience, from daytime soaps, whatever. Talk about what you want and why. Ask your doctor to help you with this paperwork and to explain what happens in real life. Ask your doctor, how often does CPR really help? Does receiving IV fluids help or hinder with suffering as someone is passing away? Consider your goals. Where do you want to die? Home? Hospital? Then, put it in writing. (Your doctor or NHDD.org can help with resources).
Our conversations with our patients about end of life go more smoothly these days. We've taken care of too many patients where we had to guess what they would have wanted at the end of life. Guessing isn't easy, and our patients may not have always received the type of care they would have wanted.
We've learned from our experiences. When you approach the end of your life, your loved ones and your health care team want to respect your wishes. We can't do that if you don't tell us what is important to you. What is the first step you can take today?
Dr. Julie Gunther and Dr. Kathleen Romito are Boise physicians.