As a physician, I want to emphasize that discussing end-of-life care is not just for the elderly and the dying. The topic is of urgent importance for everyone, even though conversations about our mortality are difficult and easily avoided.
Completing your own advance directive detailing your wishes before a medical crisis represents a true gift to your family. Encouraging other loved ones to do likewise can create a shared understanding of what each person desires should they be unable to make care decisions for themselves.
Such planning also greatly helps us as physicians. Like everyone else, we are focused on preserving and saving lives - not helping end them. We grapple with our own fears and personal discomfort about death and are oftentimes relieved when the patient is the one initiating a discussion about care options in the event of serious illness. We, as much as they, want to ensure that death is a dignified conclusion.
In an article published almost 20 years ago in the Journal of General Internal Medicine, authors wrote that "we (as physicians) must reshape our views to acknowledge death as a natural last step in the progression of aging and disease ... To help someone die in comfort, in peace, and with dignity is to give one a final gift of life."
Those words ring even truer today - for physicians and the general public alike - as advancements in medicine and technology have made it easier to sustain life far beyond what is necessary – and, in many instances, beyond what is desired by the patient.
Let's speak clearly. Despite society's best efforts to skirt the issue, death is the inevitable conclusion of life. The better we prepare for it, the easier it will be for us - as both patients and caregivers - and our loved ones to take the last steps in our respective journeys.
Statistics compiled by The Conversation Project National Survey in 2018 indicate that most respondents – more than 90 percent – agree end-of-life discussions with their loved ones are important. Yet, only about a third say they already have engaged in such conversations. Even fewer - 18 percent - report discussing end-of-life care options with their physicians. About half of the survey participants say they would be "relieved" if another member of the family broached the topic.
So, how do you get the sensitive conversation started in your own family? Here are some tips:
• Overcome first your own personal fears and truly consider what you might want done as a patient in your final phase of life. What treatments might you want or not want? Do you want sustaining, curative care to the end or shift to comfort care at some point? Talk with your physician to help think through the options.
• Lead by example. Complete your advance directive before raising the topic with others.
• Begin a conversation by, perhaps, relating another family member's experience. An uncle or aunt, for example, may have had a difficult and unprepared death - something you do not want to happen again in the family.
• Express your feelings of anxiety; indicate you want others in the family to share their end-of-life wishes.
• Acknowledge there may be disagreements as to approach or options and indicate how these might be addressed.
• Encourage loved ones to name proxies who will clearly advocate for their wishes.
Most importantly, show empathy and respect. The intention, after all, is to support others in making decisions about how they will live - and how they will complete their journey.
Visit JourneyCare.org for an advance care planning form, "Five Wishes."
- Mark Grzeskowiak, MD, is chief medical officer for Glenview, Ill.-based JourneyCare, nonprofit organization providing hospice, palliative and home health care services to seriously-ill and chronically-ill patients throughout Northern Illinois.
