Although it is a subject most individuals want to avoid, it is extremely important to discuss wishes at the end of life with your family. Changes in medical technology have made it possible to keep people alive well beyond the point where their lives may have meaning and quality to them. Patients who can’t communicate their wishes regarding their medical care can be kept alive by heart-lung resuscitation, breathing machines, artificial feeding, and other methods. By default, physicians continue treating individuals to keep them alive for as long as possible, because without consent or proper documentation, they are not allowed to switch to a comfort care approach to treatment. In these instances, an extremely difficult decision of choosing the treatment approach is left upon the family members.
By default, family members also often decide to try to keep the individual alive as long as they can to avoid the second-guessing or guilt that may come with other decisions.
Individuals can avoid this difficult process and time by being proactive and discussing their wishes for end of life with their families. This does not just involve filling out advance directives, including a living will and healthcare power of attorney; it must be paired with a discussion with family to clearly explain your wishes in the instance of a life-threatening illness or accident. Discussing your wishes in advance and when everyone is calm helps prevent disagreements from arising during a critical and emotional time, and takes some of the burden of decision-making off your loved ones during this difficult time.
This is a chance for individuals to let their family know if they would prefer a comfort care approach in which they could spend their last days comfortable at home. Filling out advanced directives is an important part of the process as well. Just giving a big picture idea of what you want the last chapter of your life to look like helps guide your health care provider and family and sets a standard of care they can use when making decisions.
Preparedness is key, and the sooner an individual discusses their wishes at the end of life with family, the better because we never know when a life-threatening event will occur. Our community is fortunate, as Cone Health offers exceptional family medicine, social work, spiritual care and other related services dedicated to providing the education and resources needed for the process of preparing advance medical directives and how to discuss wishes at the end of life with family.
Talking with family and preparing advance directives is especially important for divided families and non-traditional relationships, as long-standing, unmarried couples do not have legal standing in these situations unless otherwise noted.
Dr. Bill Hensel is the program director for Cone Health Family Medicine Residency and a family medicine specialist. Dr. Hensel is a 1978 graduate of Ohio State University College of Medicine. He completed his residency in family practice at University of Texas Medical School at Houston in 1981 and completed a fellowship in faculty development at the University of North Carolina at Chapel Hill in 1985.