Making End-of-Life Decisions
In “Frank Talk About Care at Life’s End” (New York Times, 8/24/2010), Jane Brody discusses the recently-enacted New York law signed by Governor David Patterson that requires doctors who treat patients with terminal illnesses to give them information about aggressive pain management and hospice care to consider in making their end-of-life medical care decisions. There is a similar provision in the original Federal health care overhaul proposal. (It was withdrawn after all the “death panel” objections.)
Many patients are now living longer with incurable diseases (such as cancer) so that it is difficult for people to accept the information from their doctors that no further options are available. (It is also difficult for doctors to admit that they are at the end of their ability to help a patient.) 
What results is a trend to pursue a cure, even though it often destroys the possibility of good quality last days, surrounded by loved ones, in complete physical comfort at end of life.
Studies show that less aggressive end-of-life care can actually result in living a few months longer and with less depression. But in order to have that, one must give up hope for a cure. I have never been in that situation and don’t know whether I would opt for aggressive treatment, or if I would choose palliative care. It is a very weighty decision.
When making end-of-life decisions, you (or your families) need to be informed of all of the medical and palliative options. Many terminally ill patients choose comfort care after receiving realistic information about their change of survival and how difficult and painful future treatment is likely to be.
It is good to have end-of-life conversations with your family. I had many of these discussions with my former mother-in-law, Marian (who remained my friend after the divorce) before dementia set in. She told me she did not want to live a life that she could not reasonably enjoy. 
By the time her dementia set in, she was in no position to make arrangements to end her life. Her loved ones cannot help – assisted suicide is considered murder in most states (although not in all countries around the world).
You could look Marina’s plight as a waste of scarce resources. Her medical and caretaking costs are huge. She will never get better absent a medical advance tantamount to a miracle. This money could be used for dementia research, or for starving people in the world, or to help fix environmental problems.
What if my mother-in-law had been given a choice of ending her life 5 years ago? Could she have made that decision and put it into effect? It’s involves determination and set of actions very few people can accomplish. In a way, then advanced cancer has the advantage that you will die, without having to accumulate pills to do it yourself. That is a fortunate silver lining to having a dreaded disease such as cancer.
© 2010 Laurie Israel. All rights reservied.
