How to Make Doctors Think About Death

An Opinion piece was recently was published in the New York Times by Theresa Brown entitled, How to Make Doctors Think About Death.  It was a great piece and right on target.  It discusses how often physicians are, out of habit, treating symptoms without seeing the big picture in a dying patient.  It can be difficult for the physician to admit s/he has run out of options and there’s nothing left to do.

Here is an excerpt from Ms. Brown’s Opinion:  

It made sense to switch him to “comfort measures”: to focus on alleviating his suffering rather than curing him.  It would also make sense to have general treatment guidelines for situations like this, guidelines to indicate when comfort, not cure, is most appropriate. But no such guidelines exist.”

The sad truth is that no such guidelines exist for physicians. However, guidelines do exist for patients!  The other sad truth is that most patients don’t know it. They follow suggestions and prescriptions and trials and more trials even in the face of their oncoming demise. Everyone wants to think the next great idea will be the one to pull the patient back from the brink of death into a life full of meaning and options again. This is rarely the case.

At End of Life Choices California, we believe in planning ahead for such a situation. In addition to the Advance Care Planning documents we have provided on our website,we also offer information and advice about how to specify exactly what you want and don’t want at end of life. We all need to be specific about our wishes, discuss them and write them down. EOLCCA is available to help individuals as well as provide information about advance care planning to community groups and other organizations.

We DO have options at the end of life. We do have choice. We just need to know about it.

Please take the time to educate yourself, talk with your physician, talk with your family.  It matters not whether you are young or old, sick or well. All adults should think about this and write down their preferences.  We will not live forever and none of us knows how the end will come. Every day is a gift, so be sure your loved ones know what your ending looks like, should it come as a surprise or as an expected outcome of disease.

Happy Launch Day, End of Life Choices California!

From Merriam-Webster:

LAUNCH: to throw forward : HURL; to release, catapult, or send off (a self-propelled object); to set (a boat or ship) afloat; to give (a person) a start;  to put into operation or set in motion : INITIATE, INTRODUCE; to get off to a good start.

All of these descriptors apply to today’s launching of the brand new End of Life Choices California’s website. We particularly like ”to get off to a good start” although catapult sounds interesting too. This is our hope and dream; to get EOLCCA off to a good start. The four of us; Karen, Claudia, Lynne and I all came together with this brave idea which has become a mission to do something to help the people of California gain access and knowledge about all their end-of-life options.  Our hope is that having this knowledge will help ensure they can have the death they envision; hopefully, a peaceful death when and where they would like to die. We formed EOLCCA in order to meet that mission.

Right at the beginning, we talked to Sue Porter, the Founding Director and Executive Director of the successful End of Life Choices Oregon and she basically told us to really think it through as it was a TON of work.  I think she used the word TON a few times in that initial conversation. We took her kind advice seriously but were undaunted by this. We all knew going in that it was going to be a lot of work and, yes, it has been a “ton” of work.  At this early stage of our organizational development, EOLCCA is an all-volunteer effort. But we are excited, enthusiastic, passionate and deeply committed to its mission.

We have all volunteered or worked in end-of-life care from one aspect or another for many decades, collectively. We have extensive experience from having observed both “good” deaths and “bad” deaths. Granted, these terms are subjective. However, most of you would agree, we hope, that there is a true difference if you have had close experience with dying.  

To us, a “good” death is a death that occurs where the dying person wishes it to occur, and for most of us, that is at home, in our own bed.  It is knowing and understanding that death is coming and preparing well for that final journey. It is having a chance to say goodbye to the important people in our lives; our partners, our parents, our children, our long-time friends, and other loved ones.  It is having a chance to finally say things that had been left unsaid. It is possibly taking a lethal dose of medication, prescribed by a caring physician under the End of Life Option Act, at the time and place of our choosing, and falling gently into a final, deep sleep surrounded by people who love us.  

A “bad” death, on the other hand, often happens unexpectedly, or following a terminal and painful decline.  A serious medical event leads to an ambulance, a hospital and intensive care. Often a ventilator, tracheotomy, or feeding tube is involved, often against our wishes.  Sometimes this kind of death comes after a devastating or long, lingering and debilitating illness that slowly robs us of our ability to perform daily tasks as we become more and more dependent on others for our care.  For some, this situation is an intolerable loss of dignity and control. Hospice and palliative care experts do an excellent job of caring for people at the end of their lives. They are trained specifically to manage pain and other uncomfortable experiences of dying. However, they too are not perfect, just like the rest of us. Sometimes, despite their training and protocols and caring, we may still have an unbearably painful and uncomfortable death with little dignity left intact at the end. This often also leaves a visual memory of our suffering observed by our families and remembered for the rest of their lives.    

We realize this is only our opinion.  Our hope is that we can reach as many people as possible in California to explain to them that they have a say in how they die.  That they have choice. To make sure they are offered the opportunity to learn about ALL of their end of life options, from hospice and palliative care, to voluntary stopping eating and drinking with excellent medical support, to the possibility of stopping unwanted medical treatment and allowing a natural death to occur, again with excellent medical support, or choosing to access medical aid-in-dying via California’s End of Life Option Act.  We want people to have this information so they can have conversations with their families and caregivers, hopefully providing the support they need and, as a result, have less anxiety and fear about dying.

The truth is that we all die.  There is no avoiding it, at least not that we know of.  Why not plan for an ending that can retain the dignity of a life lived well and offer some peace to the people you leave behind?  

So that’s why we’re here.  You can read more about what specific services we are offering on our brand new website.  Our volunteer teams provide information and personal support to Californians free of charge.  We are entirely supported by private donations. Our Mission Statement is below. YOU can help us get off to that good start by telling people about us and/or by making a donation, large or small. Everything helps. Feel free to send a check to the address below or on the website.  We would be very grateful for any help you can provide.

Lastly, feel free to sign up here to receive future blog posts which we plan to send out regularly.  We will discuss all kinds of interesting news and ideas in the world of death and dying.

Happy Launch Day, End of Life Choices California!!


End of Life Choices California provides information and personal support regarding California’s End of Life Option Act and all other legal end-of-life options to the medical community and to the public.