Have a conversation with your family about the end of life

I recently talked about how we might approach the idea of our own death. I wanted to start a discussion about how individuals engage with, think about and plan for the end of their life. In offering a medical perspective on what death is like, I hoped to stimulate self-reflection about this scary and foreign topic.

However, when we think about death, we don’t just think about our own death; we also have to consider how those we love might pass away. This is something the medical system doesn’t prepare us for, and I hope to shed some light on this topic with this article.

In an emergency, emotions are paralyzing

In my experience, when a patient arrives at the hospital with a life-threatening illness, family members are caught off guard. Even if a patient is chronically ill or has a terminal disease, family and friends are still overcome by shock when their loved one is in the emergency department with a bad pneumonia or a bout of heart failure. Seeing a loved one in distress or pain conjures many emotions. I’ve seen family members filled with shock, grief, guilt, remorse, fear, anxiety and even anger.

Physicians put an unfair burden on family members during this time

In extreme cases of medical illness or traumatic injury, the patient may not be able to express what he wants with his care. Physicians then turn to family members to discuss important decisions, such as a patient’s code status. We hope that those who know the patient best will know whether the patient wants to have their heart shocked when they go into cardiac arrest or whether they would want a breathing tube or surgery. When family members are under the duress of strong and confusing emotions, however, this is an unfair request. How can we process such important medical decisions when we feel shocked, scared and sad?

The best way to handle end-of-life decisions for others

To avoid this situation, the most important thing is to talk to family members and friends about what they’d want in the case of a life-threatening emergency. Would they want chest compressions if their heart stopped? Would they want long-term artificial nutrition? Would they want to live in a persistent vegetative state? These are hard questions, but starting a conversation is essential to making sure we do the right thing for our patients and those we love if the situation arises. Although this is most important for family members who are sick, these situations can happen for healthy people as in the case of car accidents. The only way to know what someone would want is to ask them.

The medical system doesn’t address how the family feels

In emergency situations, physicians like me focus entirely on the patient at hand; we ask these weighty questions to family members and when we get our answer, we rush to implement our treatment plan. Often, the family does not get the support they need. Ancillary staff like social workers and chaplains can often help families with grief, confusion and coping, but medical doctors neglect this essential component of caring for the community. I hope that as a physician, I can remain mindful of a patient’s family and friends.

It is time for the medical system to focus on the end of life

I write about death often because I see too many situations where we don’t know what a patient wants, and he is too sick to tell us. These situations put enormous stress on family members as well as significant burden of cost and resources on the health care system. In no way am I supporting “death panels” or the withdrawal of care when someone wants everything done. But as a physician, I also cannot uphold keeping someone on life-support if that person doesn’t want it. The only way to ensure the medical system does the right thing in critical situations is to think about it for ourselves and talk about it with those we love.

Have you had a conversation with your family members about the end of life?

Craig Chen is an anesthesiology resident.  This article originally appeared in The American Resident Project.

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  • meyati

    This is horrible-This is the first comment and it’s an example of what Dr. Chen is talking about. There isn’t a discussion about death.

    I belong to some blogs, and people complain that someone is negative if they talk about death or pre-planing a funeral. Of course, I don’t have any idea if the negative person that wants to talk about such things is truly negative, a drama queen, maybe needs lots of counseling. Then maybe the people complaining about the above are people in denial.

    My X had a wonderful aunt that couldn’t take anymore heart and joint replacement surgeries. She complained that physical therapy was so hard on her, and she couldn’t take it anymore. Every time she tried to talk to her family, they said that she would be committing suicide if she didn’t have her heart jump started again. Why didn’t she love them enough to live for them? That she was a bad Christian. She was negative.

    She talked to me about it. I asked her 2 questions #1-Did she feel that doctors were playing god in keeping her alive? #2- Was she ready to meet her god? A few days after I left, she went and got a living will and DNR. She visited with her pastor that told her to tear the DNR up. She didn’t.

    I can’t go back there, as they called up the house and told my husband if they ever saw me, they’d shoot me for murdering the poor auntie.

    This is a highly charged emotional issue, which runs the gamut from: the quicker Auntie dies,the quicker I can get her property to: I want Auntie to live forever.

    In the 2 current blog discussions about handling death, several of the people commented that the counselors need to back off. The good doctor wrote that people should have their last wishes documented, and he talked about the families that didn’t have a chance for a formal good-bye-I love and forgive you. . I was surprised and relieved that I wasn’t alone in thinking this formal love fest that’s overseen and guided by counselors or whatever is over stepping by the medical community.

    Oh, I loved the question about me ‘ordering’ my family into counseling. The counselors did not like my answer. No wonder this country seems to be failing morally-and I’m a Democrat.

    I had 2 raging arguments with counselors about this formal rite and counseling. The bleating ninnies even ran to my oncologists about this. My oncologists broke out laughing when I said that my family consists of adults and I respect them as adults. If anybody in my family doesn’t feel that I love them, a stupid counselor won’t be able to convince them. They told the counselors to respect me and leave me alone.

    I’m not a drama queen. I don’t want to manage the feelings of other people, because I’m not on a power trip. I don’t want fake or scripted “I love you”. I don’t want my family forced to beg for forgiveness like a murderer on the sentencing day. My family has already impressed me with their feelings-they don’t need to impress anybody else.

    Meanwhile, I go in, and during ‘intake’ I’m asked if I have a DNR-it puts me in a rage– the EMR should show my DNR to any EMT, any nurse-even when I get a routine annual eye exam

    Now this is something that the doctors and counselors need to clean up. I don’t want to be in a car wreck-struck by lightning or whatever-have my heart stop-and be pulled back into life-pulled out of the Angels’ hands to die from this head cancer. What sense does that make? And I tell them that.

    Get busy and support National POLST in your state, so if a patient does have a DNR-that the EMTs and ER staffs Do Not Resusitate.-follow the wishes of the patient. In my state-if the EMTs get their hands on you, you belong to the state and they do everything to bring you back, even if it keeps you in a coma for 20 years or more.

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