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A recent opinion article published by three gurus in the field of Palliative Care suggests that there has been no better time than the present to have "the conversation."
The question of what one may hope for at the end-of-life, and how one might wish to die is one most commonly avoided in our society. Most of us are either scared, uncertain, or both in how to start conversations about death. Yet studies show by making time for these difficult talks, we actually provide improved psychological outcomes for one another.
"The conversation" is, in essence, discussing what matters the most to us. What makes life worth living? And at what point could life not be worth fighting for?
By talking about death, we paradoxically show how much love we have for one another, through the discussion of what makes life worth living. In turn, we can preserve someone's dignity during their time of greatest vulnerability.
Establishing the person who will make medical decisions if oneself becomes unable to do so is a good start. Yet, especially in the beginning, what exactly to discuss can be overwhelming.
We must, therefore, start with the basics. The experts provide a very straightforward approach.
Which of the following statements provided by the authors best resonates with you? Then, ask your loved one which they relate to the most.
Be brave and share with each other.
"I want to continue living even if my quality of life seems low to others, and I am unable to communicate with people. In general, I would accept the support of my breathing, heart, and kidney function by machines that require me to be in a hospital or special care unit."
Generally, I would take this first statement to indicate that the person wants everything done under any and all circumstances, regardless of expected outcomes. I think of this as the "default" option that is chosen if health care providers have no guidance otherwise as to what to do in a situation where someone is unable to communicate. Some may find such machines to be invasive or aggressive. This will vary, of course, from one person to the next.
"Life is precious, but I understand that we all die sometime. I want to live as long as I can interact with others and can enjoy some quality of life. I would accept intensive treatments only if I had a reasonable chance of getting better. I would refuse long-term support by intensive medications or machines if my quality of life was poor, and I was not able to communicate with people."
So many of us have difficulty consciously acknowledging that yes, we all die sometime. Choosing this statement may require some deep soul-searching on what one truly believes will happen at or after death. What does each of us define as a good quality of life? For some, they may have the answer in a minute. Others, maybe much longer.
"It is most important to me to avoid suffering. I do not want extraordinary medical treatments, such as breathing machines or cardiopulmonary resuscitation (CPR). If my natural body functions fail, I would refuse treatments and choose to die naturally."
Choosing this final statement can very much depend on one's present health status. Having a diagnosis of terminal cancer versus being otherwise healthy with no significant past medical history can influence making this choice. It is OK to change one's mind over time, but what is important is for families and loved ones to stay in constant communication regarding such thoughts.
Starting with one of the above three statements and subsequently expanding outwards as able can be begun in one discussion or reviewed over time. Very commonly, cultural preferences and religious backgrounds may also play a role in whether one wants such measures taken. Without discussing these options ahead of time, however, patients may be exposed to unnecessary suffering in the long-run. Could anything matter more than caring for each other in a life and death situation?
Most important is that loved ones begin discussing their wishes well in advance of the life-threatening circumstances, thereby maximizing one's preparation and future comfort.
Particularly in the time of COVID-19, "the conversation" cannot be more crucial to have in the present day.
