Based on the goal of preventing or relieving suffering, the following are questions or points which may help in making beneficial decisions.
* What’s important in your life? What are you willing to sacrifice to just stay alive? For example, would you be willing to live in a nursing home and have someone toilet you? How much ‘interference’ [as in doctor visits, taking pills or other treatments, admissions to hospital, rehab, etc.] in your day-to-day living are you willing to tolerate?
* What’s your quality of life now and what will it be after a proposed intervention? Who defines ‘quality’? For some people, they can still enjoy life as long as they can watch TV while having a beer, and have a caregiver to look after them! For others, they see no enjoyment in that, nor in not being able to walk in the woods and therefore might decide to “stop everything”.
* What are the chances it will help you get back to what you were doing? If a proposed drug or other treatment won’t give you a better than 50% chance to resume living the way you were, it may not be worth it. One family decided after their mom had a stroke and could no longer talk, garden, or look after herself, that, knowing how much she hated to be idle and have others fuss over her, she would want nothing except comfort measures.
* Do you want quality of life or quantity of years? Most seniors make it clear: it’s quality.
* Has the ‘downward spiral’ started? This may be the most important consideration regarding someone’s chance of improvement or recovery: “what’s your life been like the last few months”? The ‘spiral’ refers to the irreversible decline experienced by someone with chronic or incurable conditions as they approach their final year, as evidenced by: more hospital and doctor visits, losing weight, tiring more easily, and needing more assistance with daily activities.
With multiple chronic conditions, there’s increasing difficulty recovering from sickness or injuries as we age, and eventually we reach a ‘tipping’ point followed by the ‘spiral’—and finally death. It’s important to recognize this ‘spiral’ so that a family can prevent unnecessary tests, surgeries, or drugs which would only increase suffering for both the patient and their family (who have to watch and fret over it) and not improve quality of living.
[To be concluded next time.]