Planning for End-of-Life Care

It’s true—despite increasing lifespans and technological advances in health care, doctors can’t make humans immortal.

Although many people are alive today because of the amazing advances in medicine, there’s a death denying culture in the U.S., according to Carol Taylor, professor of nursing at Georgetown University with a PhD in philosophy and bio-ethics. Taylor spoke to a group of national journalists at the National Press Foundation’s fellowship on cancer issues in December 2011.

Ethical issues and decisions surrounding end-of-life care

“Within society there’s still a fascination with and reliance on the bells and whistles, the high tech scientific care,” Taylor said. “The difficulty is recognizing when it’s our time and not relying on dying prolonging intervention.”

Taylor says it’s important to want a health care system that individualizes treatment to patients’ values and goals. Some individuals are willing to put up with dialysis three times per week while others will not.

Taylor says some people are praying to die while others are terrified of death.

“There are people at 60 who have achieved their life goals and would be happy to die,” Taylor said.

Planning ahead

She stresses that it’s critical to do advanced care planning and that means having conversations within families so individuals can be clear about their wishes.

“Identify whom you best trust to make decisions for you and put that in writing,” Taylor says.

Daniel Sulmasy
, professor in medicine and ethics at the University of Chicago, says if the discussions about end-of-life care take place ahead of time, there is less stress on family members. Desires need to be made known about whether patients would want to be on a ventilator or have a feeding tube. Sulmasy says the University of Chicago and John Hopkins University are experimenting with having a nurse initiate these end-of-life care discussions.

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“Quite often they fear that talking to their loved one will unduly upset their loved one,” Sulmasy says.

“It’s more likely the case that the patients want to have the conversation. There’s a tendency to overestimate the patient’s desire to have life sustaining treatments.”

Taylor and Sulmasy’s tips for end-of-life care

  • For the seriously ill or dying, it’s helpful to have photos of that person in the room so health care practitioners see the patient as a real person.
  • Families should have one physician contact to update them on a patient’s condition, even if they’re seeing seven specialists.
  • Overcome fear and inertia and talk to family members to avoid stress and misunderstandings.
  • Study some sample advanced directives to help determine what’s best for you or loved ones.
  • Have end-of-life treatment preferences documented in medical records.
  • When someone is ill and being treated, take the time to clarify expectations and revisit those as treatment progresses.
  • Request an ethics consult from the hospital, or talk to clergy or the hospital chaplain for help in making decisions or counseling.
  • When considering hospice care, explore the options as there are excellent and sub-par facilities.