end-of-life care

On Death and Dying

dyingOk, so it’s not the most uplifting title of a post, but it’s one that’s been on my mind the past few weeks as I researched and interviewed people for a story on end-of-life issues. I’ll post a link to the story when it appears in Consumer Reports later this summer, but I’d just like to riff a bit about the way we view dying in this country.

The first thing we don’t seem to realize is that we are all going to die. I’ll say it again. We. Are. All. Going. To. Die. No matter how much medical technology we throw at it, something is going to kill us. So the question becomes, as one of my experts said, how do you want to die?

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end-of-life care

Why We Need Death Panels

Well, not death panels per se, but a shift  from our insistence that death is something we can defeat with technology to an understanding that, despite our best efforts, the death rate in this country is still 100 percent. The only question about our death is whether we are in charge, or whether we want to cede that power to our families and doctors who,  evidence shows, are often reluctant to give up, particularly when there are more tests, treatments, and expensive technology to throw at patients.

Two personal stories vividly illustrated this disconnect. Last year, doctors removed the breast of my husband’s 80-year-old aunt and started her on chemo when she was diagnosed with cancer, despite the fact that she has late-stage dementia.

And doctors are treating–albeit not aggressively–the early-stage vulval cancer my friend’s 90-year-old mother-in-law was recently diagnosed with.

And yet, a survey of nearly 1,700 California adults found that while more than 80% of patients think it’s important to have their end-of-life wishes in writing, less than a quarter did. Only 8% said a doctor had ever talked to them end-of-life issues.

Talking to patients about end-of-life issues could improve the way they die. So why … Continue Reading

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end-of-life care

Why are we so afraid of death?

My cousin’s mother-in-law is in her late 90s. She had horrible osteoporosis and can barely move. She has little cognitive function left. She requires nearly 24-hour care and no one would even attempt to say she has any quality of life left. She told her son years ago that she was “ready to go,” and had had enough.

And yet when I asked my cousin’s husband if his mother had any do-not-resuscitate orders, or had ever completed an advanced director  outlining her wishes of what kind of end-of-life care she wanted, he said no. His sister, he said, just wasn’t ready for that yet. So what, I asked, will you do when/if your mother gets pneumonia? Will you treat it with antibiotics? Will you put her on a respirator? If she is no longer able to eat, will you feed her through a tube?

He couldn’t answer. And he was clearly uncomfortable with the questions.

Therein lies the rub. These are conversations that this woman, her doctor and her family should have had years ago. Heck, I’m only 48 and yet my husband and I completed our durable powers of attorney and advanced directives outlining our end-of-life wishes years ago. … Continue Reading

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end-of-life care Medicare