This is Part II of “What is suffering and what can we do to relieve it?”
To recap: suffering is distress with no end in sight. It is very personal: one person cannot judge if another is suffering. The historical goal of medicine has been to relieve and prevent suffering.
If your grandfather has a life limiting disease and wants to avoid suffering, he has several options as he approaches the end of life [EOL].
But, because both doctors and families may forget that some people have priorities other than just living longer, you and he need to clarify a few things. Here are four questions [from Dr. Atul Gwande’s new book, Being Mortal: Medicine and What Matters in the End] your family should discuss with him:
#1. What is his understanding of his current condition?
#2. What are his goals if his health gets worse?
#3. What frightens him the most about his health situation?
#4. What is he willing to trade-off, to give up, just to stay alive?
Based on that discussion, he has a range of choices (his goals) from: “keep me alive regardless of suffering” [do ‘everything’], to “just keep me comfortable” [do only things that provide comfort].
Option 1: At one end of the spectrum, keep doing everything; don’t change the pills, tests, doctor visits, etc. Do whatever is needed to live, including CPR [cardiopulmonary resuscitation].
Option 2: Stop prescriptions and tests which don’t contribute to comfort. But, he could still have surgery, etc if it offers a better than 50% chance of improving his comfort. This is essentially what Palliative Care encourages. For example, if he has severe COPD [Chronic Obstructive Pulmonary Disease – emphysema] and realizes nothing more can fix it, he could stop his cholesterol-reducing pills, vitamins, etc, since these have little benefit unless someone has more than 1-2 years to live. (the American Geriatric Society and the American Medical Directors Association promote this through the Choosing Wisely program).
Option 3: Stop everything except what controls a particular pain or other symptom. Hospice might be considered, if his estimated survival is less than six months, to maintain comfort.
Next time: two more options.