Today, two items regarding end-of-life and having a conversation about one’s own mortality. Medical directives are imperative to ensure living and dying the way you want. The following chat and op-ed give you lots of food for thought.
For more than a year now, Los Angeles Times columnist Steve Lopez has been writing and talking about how we die. On Thursday, he hosted a Google+ Hangout with Dr. Judy Epstein, clinical director of the Compassion & Choices organization’s End-of-Life Consultation Program, and Kathryn Tucker, director of legal affairs for Compassion & Choices, which advocates for patients’ rights on end-of-life issues. Here’s the video of the chat:
Here’s an op-ed column that appeared in today’s Albuquerque Journal. It was written by Dr. Aroop Mangalik, Professor Emeritus of Medicine at UNM School of Medicine. The paper titled it “Take Control of Life, Death.”
If you want to be comfortable, happy and be with your family and friends when you are facing a serious illness or are likely to die in the near future, you need to take control.
In recent decades, there has been what some have called “medicalization of death.” There have been many advances in medicine and a lot of people are living healthier, longer lives.
But ultimately, we all have to die.
Medicalization of death has occurred, to a significant degree, because we – society, patients and doctors – have not taken into account the fact that there are limits to life and that medical interventions can only do so much.
Understanding this reality is a major step that must be taken to get the best outcome for the patient.
How does one understand this? How do we take control of the situation?
The knowledge you need to get will necessarily come from your medical provider. The best decisions are made by having the facts – available treatment options and the likely outcomes.
Ask your provider about the nature of the illness and what is expected without any treatment.
The next steps will be to get a clear picture of what treatments are available. You should be able to get some idea of how likely it is that the treatments will improve the outcome for you.
This includes information on previous success and failures with available options. At least try to find out if the treatment is “very likely,” “likely,” or “not likely” to help.
Equally, important, you need to know what will be the side-effects of treatment. Will the treatments be harsh or mild, will they last for a short time or will they be persistent.
The cost in dollars is also something that must be considered. In this day of uncertainty we cannot ignore that factor. Many families face bankruptcy because of “long shot” medical treatments.
Once you have the information, you need to decide. It should be your decision based on the best information and input you can get.
If you feel that the treatments available to you are not going to help you achieve your goals, you can refuse those treatments. No one can force you to have a treatment you do not want.
If you choose the path of not taking the treatment, the focus changes from controlling the disease to making your life as comfortable as possible.
The medical team will work with you to control your symptoms. They will help you with pain control, nausea, vomiting, shortness of breath or difficulties in performing day-to-day activities. They will work with you to get the best out of life for whatever time you are alive.
There are many types of experts who are trained to help you. They have overlapping roles and expertise and they work together.
They are referred to as Palliative Care Specialists, Hospice Teams or Symptom Management experts. They all have the goals of making your life better and focus on you.
They also help you and your family so that you die comfortably and with dignity with your family and friends around you.
In certain circumstances, despite their efforts, living may feel like a burden. There are other options that can be utilized.
This is the option of you willfully ending your life at the time you choose. This option has been given a number of names. Physician-assisted death (and) assisted suicide being two common ones.
The option is currently available in Oregon and Washington State. In New Mexico, we are waiting for the courts to decide if such an action would be legal.
In summary, when faced with a serious illness, you should take control of your life and decide what is best for you.
This column is written on Dr. Aroop Mangalik’s personal capacity and is not reflective of the UNM Health Sciences Center.