Monday, February 7, 2011

Let's talk about end-of-life care

There has been enough talk about death panels and too little talk about end-of-life care.

As I typed those words, a new e-mail popped across my computer from Art Caplan, a nationally known medical ethicist from the University of Pennsylvania.

We had both read the new policy statement from the American Society of Clinical Oncology urging doctors to talk with patients about their end-of-life wishes.

Here's a link to Caplan's blog on MSNBC:

And here are some other links to get you started.

ASCO offers a free booklet, "Advanced Cancer Care Planning," to help initiate candid discussions between patients, their families and physicians about treatment options, including palliative care. You can download the booklet from the society's patient web site:

Hospice & Palliative Care Charlotte Region also offers many helpful resources on its web site: Click on "Information for patients, families & the community" to read more about palliative care. Or try "Professional and Community Education" for information about advance care planning documents such as living wills and health care powers of attorney. At "About us," you can find answers to frequently asked questions (FAQS).

Carolinas Center for End of Life Care also offers plenty of help at


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Anonymous said...

My mother wanted to be sustained and kept alive by all means possible (which goes against what most people want to do, but that was my Mom for you!). She even signed a document which stated so. But when it came time to put this into action when she became ill, her doctors were constantly pressuring me to sign a DNR (do not rescuscitate). I told them under NO circumstances would I sign it, and that she wanted the total opposite, she wanted to LIVE. One doctor even got so angry at me he stormed off in a huff. Why can't doctors understand that some people DO NOT want to pull the plug? My mother was the strongest woman I've ever known--living through 3 heart attacks, 3 open-heart surgeries, a stent implantation, lung cancer (which she beat through chemo and radiation), and emphysema. In the end it was the congestive heart failure that caused her demise.

There needs to be a discussion about, and doctors need to know, that not everyone wants DNR and some patients want to be kept alive--for their families as well as themselves. To deny anyone their last wish, as they attempted to do with my mother, is nothing but selfish and a horrible way to treat the patient's family.

rudydaniels said...

The question would be how would you feel if for some reason during one those incidents that your mother had a severe stroke and was not going to have any quality of life living on a vent. How would you feel if the doctor did not reevaluate the situation?

MDs are required to reevaluate - and though I do not agree with the one who stormed off - it is a legal obligation to continue to ask with each admission to the hospital, each procedure and during care.

Pulling the plug is a very old term that is no longer used. Medicine has advanced so much that there truly are times when nature needs to take it's course. It sounds like your mother surely was strong - but at some point nature did take over.

Anonymous said...

As an ICU nurse of 30 years I have seen patients and families go through hell because we continue to offer everything to patients regardless of their age, diagnosis or prognosis.

When will we as a society realize that we all die? That there comes a time when it's unreasonable to continue to do things that will make no difference in the final outcome? When will we realize that a peaceful dignified and natural death isn't giving up, it's understanding that we all will die?

Isn't it better to die without machines, pain and strangers but surrounded by loved ones, in comfort?


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