Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Pledge to end your fear of death and end-of-life care

Paul Hébert, MD and George Heckman, MD
Physician
March 13, 2019
1K Shares
Share
Tweet
Share

Are you or a loved one aging, perhaps with a chronic heart or lung condition that limits daily activities? Do you have an older parent in a nursing home or who needs assistance with daily living activities? If so, read on and make the pledge.

As physicians, we see death every day. We see death made worse and more painful by poor advance care planning. Yet, despite the certainty of death in all our futures, it is astonishing how often families and loved ones have neither discussed nor planned for the inevitable.

Discussing death is hard. But not having these crucial conversations is far worse.

Over 50 percent of Canadians who die each year do so in hospitals. We no longer die quickly at home from acute illnesses like infections, but from chronic illnesses whose protracted course often ends in hospitals. Death has been removed from daily life and is managed for us in sanitized institutional environments. Perhaps because death is less familiar, it is easier to fear. It is certainly much easier to ignore.

Consider older nursing home residents, most in their mid-80s, many of whom have some dementia, have daily pain, depressive symptoms and are affected by diabetes, heart and lung disease or stroke. “Frailty” is the term used to describe such persons, whose complex burden of age-associated conditions increases their risk of further decline. Their life expectancy is normally around 18 months — shorter still if they lose weight, need more assistance or become short of breath.

Because we do not have crucial discussions, as many as 30 percent of frail nursing home residents are admitted to an intensive care unit and 50 percent to hospitals in their last month of life. Because we have not normalized difficult conversations around death, we will never know whether this is what they would have wished.

A key reason is fear.

Fear of death, fear of the unknown, fear of dying in pain and alone. Fear of talking to doctors and nurses about death. Fear of being abandoned if they forego aggressive care options. Fear of dying in pain and alone in a community ill-equipped to address their needs.

Doctors and nurses are also afraid. They have limited training with difficult conversations. They fear the sense of defeat from the sense that they are giving up on patients. Fear is why these discussions don’t happen.

So, this year, pledge to overcome your fear of death and have an end-of-life discussion with your frail loved ones and with your doctors and nurses.

Reflect on what matters to you most, your values, your life goals and expectations and anything else you feel is important. Ask yourself: how do your wishes align with the specific and best-practice care choices that you might have to make, today, or in the future? Know that you can seek help from your doctor or nurse, or use one of many available toolkits.

Once your wishes are clear, it is critical that they be honored. Write them down. Share them with your loved ones and powers of attorney, who need to know because they might have to speak on your behalf one day if you lose that ability. Share them with your doctors and nurses. Know that you are allowed to change your wishes, especially as your health changes.

Our health care system must pledge to overcome its inertia and engage decision-makers and community stakeholders to ensure that all people have equitable access to quality services that support their wishes as they approach the end-of-life.

Failure to do so is a pledge to continue with 3 a.m. “do everything” resuscitation attempts that prevent natural death and that many frail patients would never have wished for had that crucial discussion taken place.

Paul Hébert is a professor of medicine, Université de Montréal, Montreal, QC, Canada. George Heckman is an assistant clinical professor of medicine, McMaster University, Hamilton, ON, Canada. Both are researchers, Canadian Frailty Network.

Image credit: Shutterstock.com

Prev

Why do patients call me by my first name?

March 13, 2019 Kevin 35
…
Next

How Tom Brady and Lebron James can change your patients' health

March 13, 2019 Kevin 0
…

Tagged as: Palliative Care

Post navigation

< Previous Post
Why do patients call me by my first name?
Next Post >
How Tom Brady and Lebron James can change your patients' health

Related Posts

  • My grandfather’s death: What I’ve learned about life

    Munera Ahmed
  • Why health care replaced physician care

    Michael Weiss, MD
  • A real-life example of irrational health care spending

    Taylor J. Christensen, MD
  • How social media can help or hurt your health care career

    Health eCareers
  • End-of-life care talks begin at home: even for doctors

    Abdel Albakri
  • Can the dwindling numbers of primary care physicians explain decreased life expectancy?

    Niran S. Al-Agba, MD

More in Physician

  • Discover your true north: Navigating life’s confusions and embracing your path to success

    Tyler Jorgensen, MD
  • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

    Anonymous
  • From journalism to medicine: Unveiling the untold stories of patients’ medical conditions

    Veronica Bonales, MD
  • A mentor’s legacy in medicine, leadership, and embracing evidence-based care

    Arthur Lazarus, MD, MBA
  • Breaking free from restrictive covenants to combat burnout

    Raya E. Kheirbek, MD
  • From medical student to intern: Discovering a deeper connection with patients

    Johnathan Yao, MD, MPH
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • Unlock financial freedom: The physician’s guide to lucrative multifamily syndications and wealth accumulation

      Pranay Parikh, MD | Finance
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
    • From journalism to medicine: Unveiling the untold stories of patients’ medical conditions

      Veronica Bonales, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • New Antiviral Option for CMV Prophylaxis After Kidney Transplant
  • Antibody for Infant RSV Heads to FDA for Review
  • Is Getting Test Results Online Right Away a Good Idea? Yes, Patients Say
  • Residency Application System Cuts Section on Hobbies and Interests
  • Workplace Harassment, Cyber Incivility High for Minority Groups in Academic Medicine

Meeting Coverage

  • Phase II Study: Bispecific Oral Drug Tops Leading JAK Inhibitor for RA
  • Closing the Diversity Gaps in Urologic Oncology Leadership
  • Certain NSCLC Patients May Be Able to Stop Immunotherapy at 2 Years
  • No Survival Benefit With Immune Checkpoint Inhibitor Rechallenge in Metastatic RCC
  • Happy Sleep, Happy Couple?
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • Unlock financial freedom: The physician’s guide to lucrative multifamily syndications and wealth accumulation

      Pranay Parikh, MD | Finance
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
    • From journalism to medicine: Unveiling the untold stories of patients’ medical conditions

      Veronica Bonales, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...