The Freedom of Choice

It’s one of the most difficult conversations we can have.

90% of people say that talking with their loved ones about end-of-life care is important.
27% have actually done so.  Source: The Conversation Project National Survey (2013)

It’s actually a conversation about how you want to live at the end of your life.

Personally, I hope to go to sleep one night when I am very old and not wake up in the morning.  I suppose I am not alone with that thought.  But the reality is, most of us will not die that way.

Most of us will die from:
·      heart disease
·      cancer
·      chronic respiratory disease
·      accidents or
·      a stroke

And here’s the thing…chronic conditions like heart disease, cancer and respiratory disease are just that, chronic.  That means you’ll live with the condition over time, requiring years of medical management.

I believe when a chronic condition is diagnosed, after the plan for management is established and treatment is underway, the next conversations should be what the disease will look like in the end…someday.  Talking about that topic, how the disease will actually lead to death and introducing it at the beginning of the diagnosis, allows for conversations over time of what to expect.

Now I am sure there are a few who may disagree with this idea.  That’s okay.

Let’s say a conversation might go something like this:

Over time, there will be serious events related to your emphysema that will require you to be admitted to the hospital.  And during those hospital stays, you may be placed on different oxygen masks and have aggressive respiratory therapy and at some point, you may require a ventilator to help your breathing.  These episodes may happen more frequently as the disease progresses.  I’d like to set up an appointment to talk with you about the choices and decisions we’ll have to make down the road.  It’s important for you, for me and for your family to understand what your wishes are as the disease progresses from today to tomorrow, to many years from now and all the way up to the end of your life.

Now the door has been opened and the opportunity is there to discuss the choices in detail and start thinking about future decisions.  It takes a while to digest all of the information.  And over time the choices and decisions can change.  I believe we can do better with these conversations. 

A friend of mine with cancer asked me how she would die, given her diagnosis and prognosis.  What would likely happen in the end?  I talked openly and honestly about the possibilities with her.  Some of her family and friends also had questions about how the end might look.  The conversations were difficult but so important to my friend, her care team, family and friends.  Once the tough topics were discussed and after the decisions were made, through the freedom of choice, the focus then went back on the business of living.

“I have an advance directive, not because I have a serious illness, but because I have a family.”
– Ira Brock, MD

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