Tuesday, January 22, 2013

When is it time to let go?

Too often, my clients receive much in the way of treatments long after physicians know that the treatment is not going to cure or alleviate physical symptoms. It confounds their care plans, causes much grief, stress and caregiver health issues.
It prolongs a life in which quality of life has gone.

Read more of my articles about A Good Death.

Also, you must read:

Hard Choices For Loving People - Hospice

From “Hard Choices for Loving People” by Hank Dunn. Changing the Treatment Plan.
In almost two decades as a full-time chaplain at a nursing home and in hospice, I have thought much about medical interventions on behalf of patients at the end of their lives. I have considered CPR, artificial feeding, IV therapy on the dying patient, hospitalization, and even the use of antibiotics and diagnostic work on failing patients. Often, in the eyes of my colleagues on the medical team and in my own opinion, these treatments are not medically indicated, marginal in their benefit (if there is any benefit at all), increase the burden of living, possibly prolong the dying process, and are not required by ethics, medicine, law, morality, or faith. Why are they done?

Ken Murray wrote an anecdotal essay on physicians’ end-of-life decisions called How Doctors Die (2011).

Doctors Really Do Die DifferentlyResearch Says That More Physicians Plan Ahead, Reject CPR, and Die In Peace

One of the clearest indicators we have is a survey from Johns Hopkins University. It’s called the Johns Hopkins Precursors Study, and it’s based on the medical histories and decisions of students from the School of Medicine classes of 1948 through 1964 who volunteered to be part of the survey. According to the study, 65 percent of the doctors (or former medical students) had created an advance directive, i.e. a set of legal documents spelling out in advance what sort of end-of-life care they would like. Only about 20 percent of the public does this. When asked whether they would want cardiopulmonary resuscitation, or CPR, if they were in a chronic coma, about 90 percent of the Johns Hopkins doctors said no. Only about 25 percent of the public gives the same answer.

the attributes of an ideal death as follows: 

  • being in control, being comfortable, 
  • having a sense of closure, 
  • having one’s values affirmed,
  • trusting in care providers, and recognizing impending death. 
Hospitals cannot help with most of these things. Unfortunately, most patients do not see their wishes fulfilled.

Picture these kinds of compressions on a frail 80-something woman. It's not pretty.
It breaks their bones. Consider a DNR order and advance care directives.

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