When we plan the least
When expectant parents are planning for their newborns, it’s commonplace to seek out trusted medical offices that are aligned with their needs and values. Similarly, it’s a common practice to seek out multiple doctors’ advice when we get injured, or receive a serious medical prognosis. We reach out to family members and friends for their input. Our goal is to feel like we’re in good hands – trusting our doctors with our well-being. This is an understood and common practice that is repeated throughout our lives. However, there is one time when this practice is too often abandoned.
It’s the time when we approach the end of our lives.
Planning for the end of life is unique to any other human life experience. Raising the topic with family members or friends is not easy. Talking with our doctors about our end of life is also difficult and not commonplace. Even when confronted with a terminal condition, the sensitivity around death causes many doctors to be reluctant about initiating such discussions and to instead rely on their patients to raise the topic.
So we need to raise the topic of our end-of-life wishes and start the discussions early. Like other times in life, it’s not only our prerogative to prioritize having healthcare providers who are aligned with our needs and values, but it’s also in our utmost interest to do so.
There are many paths
You have a range of paths to consider when approaching the end of life. We describe several end-of-life options on our website. The available paths we discuss include stopping unwanted medical treatment, receiving care and treatment specific to the dying process (such as with hospice and palliative care), voluntarily stopping eating and drinking, and other options for those who qualify, including the California End of Life Option Act. Guidance for how to discuss these options with your doctor is included on our website here.
Another great resource for how to talk about end-of-life options is provided by the organization called The Conversation Project (part of the Institute for Healthcare Improvement). They provide step-by-step guides for how to have end-of-life conversations. One of their guides is focused on talking with healthcare providers; you can find it here.
The guide provides practical suggestions for raising the conversation with your doctor. One suggested statement is: “I want to talk about my goals for care and living with my serious illness.” Another suggestion shows how a conversation might begin along these lines: ”My nephew recently died in the hospital after weeks of aggressive care. That’s what he wanted, but I don’t want that. I think I might prefer to die at home. How can we make a plan for that when the time comes?”
Every one of us will have our own unique end-of-life experience. Initiating discussions to influence our dying process will lead to conversations resulting in greater clarity and enabling a death with a sense of peace.
Becky Oliver is a volunteer with EOLCCA. Her professional life has been spent as part of Silicon Valley’s tech industry. Outside of work, her personal passions include contributing to end-of-life causes, with a specific interest in the nature of care for the aging and those nearing end of life.
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Thanks so much for your interest.
Hi, here’s a question that may seem odd.I’m 54, I’ve been surviving w/ stage IV metastatic breast cancer for 10 years. I have ideas about my end of life goals but I don’t know when the right time is.The cancer is progressing and as my oncologist said there are no other trials or meds to stop the spread. I’ve had many new tumors over 10months & quality is not what it was a year ago. My body has weakened but I feel so strong mentally almost as if I’d be wasting time going in for end of life
Discussion. Is there a “right time”? I get so confused. Thanks,AnneM.
We are in our late 70’s and are finding it very difficult finding a good primary care doctor where we live in the 92028-area code that will go along with our end of life wishes and comply with the California End of Life option act. Do you have a list of doctors in our area that we can talk to about this subject and will comply with the CA End of life Act according to out wishes? We are in North San Diego County, and I am in Medicare Advantage; Nancy is in regular Medicare.
Preferably a doctor’s with a degree in internal medicine.
One of our volunteers will be back in touch with you. Thanks for reaching out.
I have raised this subject with my neurologist. It was completely unsatisfactory. His response (verbatim) was “Those aren’t medical issues. They are quality of life issues. Have you spoken with a therapist?”