Hints, Tips & Advice

End of Life Conversations

In our life, we are required to handle many stressful situations. The most stressful, the one that is a life-altering situation, is dealing with the passing of a loved-one. This creates so much stress that it is imperative that multiple discussions be held with specific people in order to make certain that all aspects of this situation run as smoothly as possible. This stress often redefines our very core.

When a loved one enters into the no return zone of life, where death is eminent, so many areas need to be addressed immediately. It is way too easy to become overwhelmed and thus become immobilized.

Some of those specific topics that need to be addressed are:

•   Treatment choices
•   Treatment failure
•   Advanced Directives
•   Coping abilities
•   Suffering of both the patient and the family
•   Referrals to Hospice
•   After death issues

For those who have not yet had to experience such situations, the natural tendency is to shy away from the hard discussions. This hesitancy to have these talks, the really tough conversations, can be found in both the health care professional and within the family. No one is immune to this type of stress.

Some of the issues that surround the inhibitions to having these discussions are:

•   Shyness
•   Confusion
•   Cultural tendencies
•   Family denial
•   Inability to understand the nature of the illness
•   Fear of death/dying

It is important to find a place to begin discussions revolving around the end of life issues. Maybe a group situation might make it easier; such as during the Holiday season when families tend to gather together. These conversations can benefit from the “safety in numbers” theory and tend to be more philosophical than one-to-one situations.

Generally speaking, there are four (4) steps to expressing end of life wishes:

1. Ask the right questions
2. Record those answers
3. Discussions among the pertinent people (i.e., family members, loved ones, doctors, attorneys, etc.)
4. File documents (i.e., make certain that the important documents are filed on your computer in a separate file labeled “Advance Directives” – these papers should also be duplicated and a copy given to your attorney for safe keeping, and a copy should be saved in your safe deposit box for easy access by the family)

There are many, many questions that could be asked, and even more variations in how to ask those questions. Yet, the following few questions would be a good, solid beginning to a productive discussion of end of life issues:

•   Who do you want to make the tough medical decisions in the situation where the patient is unable to do so?
•   What types of medical treatments should be used or not used?
•   Where would your loved-one prefer to die – at home, in a hospice unit or in a facility?
•   After the death, will there be organ donations (allowing the body to be used for science, etc.)?

After the difficult questions have been asked and answered, certain documents are prepared from those answers. Those documents are often labeled, “Advanced Directives.” They can include Living Wills, Medical Durable Power of Attorney, and Do Not Resuscitate (DNR) orders.

It is obviously one thing to write about what you should do to initiate these difficult, but necessary discussions. However, it is quite another issue to face the reality of what to actually say when you are facing a loved-one and thinking about how best to break the ice with the topic of death and dying.

To assist you, here are a couple of ideas of how to break into the topic:

•   “Dad, have you ever heard of Advanced Directives? They are legal documents focused on helping the medical community in helping provide you the proper treatments.”
•   “Hey Mom, I’d like to have a discussion with you about some difficult areas. I know the discussion may be painful, and if you think you would like to consider some of the points before our meeting, we can make an appointment for another time in the near future.”

When end of life discussions take place between doctors, family, and patients; all the participants tend to feel better. Medical treatment is usually handled with more professionalism and is more effective. And, perhaps the most difficult to measure, the stress of such a difficult situation is drastically reduced.

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