At Compassion & Choices we encourage people to plan for death so they can enjoy life. If you already understand the importance of completing an advance directive, then communicating with your physician is your next step. The day you start considering end-of-life options is no time to discover your doctor's values and beliefs don't match your own. If on the other hand, you learn now that your doctor does support your making choices, you can rest easy in that relationship.
There are plenty of stories of doctors who aren't forthcoming about prognosis, avoid discussing hospice, and disregard advance directives. In most cases, Americans end up dying in the hospital when they would prefer to spend their last days at home. In the worst cases, people whose wishes are denied suffer a traumatic and painful death.
Fortunately, there are many wise, forthright and compassionate doctors prepared to be your companion and ally. You will find them eager to offer cure, care and expert advice, but also willing to let you direct the last scene of your life, when it comes to that.
This post comes in praise of physicians who put the "care" in healthcare. I think, of course, of icons like Dr. Timothy Quill, who wrote A Midwife Through the Dying Process, and all those who came under his magnificent mentoring. I think of the gentle doctor who sat at my mother's knee and cried as he broke the news that her husband of sixty years was gone. I think of the researchers and practitioners at Dartmouth Medical School who lead an emerging "slow medicine" movement to put the brakes on aggressive, intrusive procedures for frail elderly. I think of those who know "truth" and "hope" are not mutually exclusive and a doctor's job is to share both. How do you find one of them?
At Compassion & Choices we often tell people to interview their doctor. You might like some clues now to what your doctor's approach might be later. What kind of question would get your doctor to open up?
I recommend starting with a positive, upbeat declaration that, by gum, you feel healthy, you love life and you intend to savor its fullness as long as humanly possible. But you also believe in preparedness, and you'd like to make sure the two of you would be on the same wavelength in an end-of-life situation. Try one of these questions:
- Doc, if I had an illness that looked pretty grim, how would you feel if I wanted to take a pass on the heroics and let nature take its course?
- I wouldn't want my family fighting over keeping me alive if I were in the condition of Terri Schiavo, with no chance of recovery. How would you handle a situation like that?
- What if I were dying and really struggling with pain or other agonies? Would you prescribe enough pain medication and sedatives to keep me comfortable, even if it meant my life might be a little shorter?
Above all, value humility in your physician. Find a doctor who utters the words, "I don't know" and you've found true gold.
Happily, the time is gradually passing when the doctor's only source of pride lies in "doing everything" possible to prolong life. Some also take pride in serving as midwife to a good death.
I spent my formative years as an intensive care nurse, and to my everlasting shame, I pushed down tubes and pounded on chests and delivered electric shocks to many whose greatest need was for a little quiet time and the caress of their beloved. Treasure the doctor who might respond to a family asking that "everything" be done, in the way suggested ten years ago by Duke University physician David Pisetsky:
"I would like to say, 'Family, only you can do everything. Only you can talk of your love and give kisses before the skin is cold. Only you can talk of the future and of dreams to be fulfilled. Only you can talk of the past when life was resplendent because time seemed infinite. Family, only you can oppose the flow of time and enjoy one last day together. Only you can give peace and sustenance for the next journey. Family, only you can do everything. I am only a physician. I can do nothing at all.'"
Find a doctor like that!