Suffering – Part 2

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.