Never Easy, Today May Be Best to Consider End-of-Life Wishes

Your 89-year-old great aunt has been in failing health for many years.

She had been living by herself but everyone knows she has been more forgetful lately.  She had a fall yesterday and was admitted to the hospital.  She is very confused.  The doctors and care team ask you if she had given any thought to her future life and health care decisions that she will face. 

Many family members visit the hospital over the next several days.  Everyone has a slightly different idea about what is the best care plan for your aunt.

When is the right time to discuss end of life healthcare planning? While never a fun or easy subject at the dinner table, it is a necessary topic to explore. How about today, or at least, soon?   The sooner you begin learning and discussing your options, the better chance that the decisions made for you will be your decisons at the crucial times.

Unfortunately in U.S. hospitals today, many such discussions take place during stressful and critical health situations. These decisions are often made by unprepared, overwhelmed, yet well-intentioned family members.  The results may not be ideal for the individual in the hospital bed. 

Specific values and personal goals about how to spend illness or elderly years may not become clear to the family and ultimately, the health care team. In addition, there are frequently disagreements among family members to add to the stressful situation.

Regardless of your age, consider writing down your wishes in an advanced directive document and appointing a surrogate or "back-up" decision-maker in case you are not able to make your own decision for any reason.  Here are some things to start thinking about:

1. Whom do you trust to make health care decisions for you (only if you were not able to do so yourself)?

2. Have you discussed your concerns and goals with this individual?

3. What do you value most about life?  Consider things like your independence to do things for yourself and mobility (getting around by yourself).

4. If your quality of life, or enjoyment of life, was impaired due to dementia or being confined to a bed, would that be an acceptable way to live for as long as scientifically possible ? Or would a comfortable, pain free approach be your goal at that time? 

5. If the time came that you needed assistance for all bodily functions and nutrition could only be provided with a tube into your stomach, would that be an acceptable way of life?

OK, so this is not an uplifting topic and you may be tempted to think about something purple and fun and put this discussion as far out of your mind as possible. 

You are not alone.Take a deep breath. We have a couple of weeks before the Ravens' season starts.  Be proactive now and begin to find out more about this topic for you and your family. 

Ask your health care provider or a social worker for more information and the necessary paperwork.  Today is the better time.  It will not get any eaiser tomorrow.