weekly blog--one for the ages
This week’s topic is a little touchy: end-of-life care. I was supposed to go to a seminar at Harvard Medical School on the subject, but instead ended up going to the wake for a friend’s father whose in-home end-of-life care was left in the hands of his two devoted sons and their families. The takeaway on all of this…although dying is a fact of life, few people want to think about it. But one group that has no choice is the people with advanced illnesses, such as cancer, who are told they have just a few months to live. Then it becomes a matter of creating a situation that maintains the quality-of-life leading to a good death.
Essential in this paradigm is the communication between patient, family members and physician. Yet to my surprise, the end-of-life conversation has historically been especially difficult for physicians because of a natural reluctance to broach the subject, or because it conflicts with their problem-solving, hope-giving image. The good news is that there is movement within the profession to change that.
Currently, there are several programs being developed that focus on teaching physicians how to encourage patients to talk about their end-of-life wishes, and then document those wishes in the patient’s electronic medical record so that any physician in the patient’s care continuum can access it.
What helps a patient end their days as peacefully as possible? According to a number of surveys: being at home instead of in the hospital; not undergoing chemotherapy or other active treatments; not having a feeding tube; talking with a chaplain or other minister; spending time in private religious activity; having a good relationship with the health care team; and not being anxious.
One interesting survey finding: during their final days, religious people in their belief that God is the only entity that can decide when a life begins or ends, often wish for more aggressive care, which frequently entails a lower quality of life.
Readings from the Harvard Medical School seminar.
This week’s ConfrontingAging site updates of note: Perspectives/2000s &Technology--Telemedicine/Virtual Consults; End of Life Options--Online Memorials.