EOL Choices

Decisions, Decisions:  guidelines for what to do when someone has a serious or chronic illness. 

The following is a brief summary of questions and principles which may be helpful for families facing a serious, life-limiting, or chronic illness.  Discussing these within one’s family before a crisis occurs can prevent suffering, allowing for more peace and comfort as we age.

* Do you want to actually ‘live’ — or just ‘be kept alive’?  In other words, how do you want to die:  ‘with your boots on’, doing something you enjoy; or, confined to a bed with others wiping your bottom?  It’s the ‘quality’ vs ‘quantity’ dilemma!

* Are pills a burden? [most seniors say ‘yes’; the evidence confirms, we live better on fewer pills]

* First, do no harm.  Always relieve suffering.  [the primary goals of medicine]. 

* Treatments can cause suffering!  [doctors are under pressure to use the newest technology and drugs— resulting in unintended side-effects!]

* Acceptance [of a condition that can’t be fixed] can lead to serenity. [as in the Serenity Prayer].

* Should having Dementia influence decisions about other problems?    Since dementia is terminal, we often prolong patient and family suffering by treating other terminal medical problems!  Left untreated, that other problem could cause an earlier death, thereby allowing a patient to escape [what many families have described as] a ‘fate worse than death’—the progression to end-stage dementia.  [More families therefore are choosing to stop all non-comfort treatments before the end-stage develops.]

* Do seniors with a LLD [Life Limiting Disease—one eventually causing death] take treatments just because their kids want it?  [and thereby suffer longer?]

And, for family having difficulty ‘letting go’ when a patient has severe dementia:
If your loved one could tell you what to do, what would they say? If it was you in bed, what would YOU want?