By David Crawford, M.D.
No one likes to talk about death, especially one’s own. Most Americans say it is important to make sure their family is not burdened by having to make difficult end-of-life decisions on their behalf. But fewer than half have talked with their family about what they want done, and not done, when their time comes.
It is very stressful on family members when a loved one is critically ill and near death. This stress is worse if the person has never given his or her family any guidance on what they would or would not like to have done in this situation. If the loved one is so ill they are unable to communicate their wishes, it is left to the family to decide how much or how little to do. And since family members may have different views on these questions, conflicts can develop. Arguments and disagreements among family members are the last thing needed when a loved one is critically ill. Family members should be supporting each other during such difficult time.
As a physician, I have been at numerous family conferences where a critically ill patient had told no one his or her preferences. Sometimes family members started arguing over what should be done, since each one felt they knew best what the sick person would really want. Other times there was no arguing, but no one knew for sure what the patient would want done. The family chose to “do everything” since they did not want the responsibility of stopping treatments. This often resulted in a prolonged death on life support equipment that the patient never wanted. Surveys show that 70 percent of people say they would prefer to die at home. But if they have not talked this over with their family, it can be hard for the family to make sure this happens.
So, the next time your family gets together, think about having that conversation. Here are some ideas that might get the discussion started. For the parent, “When I think about the last phase of my life, this is what is important to me.” For the adult child, “How would you like the last phase of your life to be?” There is a web site, TheConverationProject.org that has a lot of helpful suggestions on this topic.
It is also important to pick who in your family will speak for you, if medical decisions need to be made on your behalf. Put your wishes in writing using a document called an Advance Directive. Your doctor can provide you with one of these, or they can be found online. Talk to your doctor about your wishes so he or she will know.
Sooner or later, it will happen to everyone. If families discuss their personal wishes ahead of time, it will make a difficult time a little less stressful. When a parent or grandparent becomes critically ill at the end of their life, and the doctor asks whether to put your family member on a life support machine in the Intensive Care Unit, the whole family can say with sadness, but also with certainty, what your family member would like to have done.
— Dr. Crawford is the Associate Medical Director of Partnership HealthPlan of California