It's common to procrastinate about having some conversations. Death is one of these. The trouble is, "there are many costs of not having this conversation" (Evans, May 19, 2009).
Despite our intentions to express our thoughts and feelings about end-of-life choices, it's simply not a conversation that many of us our willing to have, at least that's the finding in the "Coping with Cancer" study recently published in the Archives of Internal Medicine. The researchers involved interviewed 603 patients with advanced cancer who had about six months left to live asking them if they had discussed their end-of-life care with their doctors. Although they conducted this research at a leading specialist centre that provides care for people during the end of their lives, 69% reported that these conversations about their end-of-life wishes had not taken place.
The trouble, as Dr. Michael Evans reports, is that "There are many costs of not having this conversation." Dr. Evans called it "avoidance." Certainly it is, but given that palliative care for both the attending health-care providers and the patient carries with it an intention (perhaps tacit or implicit) that these issues should be discussed, I think that this avoidance may be aptly described as procrastination - irrationally delaying an intended act despite potential negative consequences. Ironically, this is putting off to tomorrow, when the possibility of tomorrow is getting more and more unlikely.
Dr. Evans notes that "the most ‘expensive' part is that patients end up dying in a way that they would not have wished" - which may include being kept alive long past their own desires. In addition to this human cost, there are financial implications noted in the results of this study with patients who didn't procrastinate on this important discussion having medical costs 36% lower than those who did not have these end-of-life discussions.
As Dr. Evan's wrote, "This signals that they made a conscious effort to plan a good death."
The costs of procrastinating on this important personal discussion with physicians and family are not just to the individual or health-care system. Family suffers too as they struggle to make difficult decisions without knowing the dying person's wishes, second-guessing what kind of treatment would be favored. What results is "more tests, more imaging, more opinions" and "the decision on reducing suffering is made only after life-prolonging treatment has been ineffectual and death imminent."
None of this is easy, not the discussions or the decisions at the time of care. Dr. Evans is careful to acknowledge this in many ways noting that, "things can change, and you reserve the right to change your mind," but he makes it clear that "perhaps it's time to look across the room at your loved one(s) and have a conversation about what a good death would look like to you."
Who wouldn't say, "maybe tomorrow"? This aspect of human nature is a classic example of an intransitive preference structure that we've discussed before. However, knowledge is power, and if we can just combine the results of this study presented by Dr. Evans with a little of our understanding of procrastination, we might be better prepared for a good death, "one that is pain free, dignified and on your own terms."
Procrastination, it's more than "the thief of time."
Reference
This brief piece was based on an article in the Globe & Mail (globeandmail.com), Tuesday, May 19, 2009 by Dr. Michael Evans, entitled, "Plan for a good death - talk about your wishes"
