One wish for all: a dignified death

Dear Dr. Gott: I am a respiratory therapist and felt compelled to write to you after your recent interest in learning how families and physicians cope with end-of-life issues. Almost on a daily basis, I see the heartbreaking results of what appears to be the chief problem between dying patients, their families and their physicians: lack of effective communication.

The comfort-only approach is possible only if patients’ families understand what that means, and it requires a physician who is comfortable discussing options at end of life.

Today’s critical-care medicine is like a runaway train. Sophisticated medical technology runs at full speed, far faster than morality. When you ask what steps we can take to ensure that our end-of-life wishes are honored, you assume that patients understand their options.

Unfortunately most patients and their families never discuss their feelings about end-of-life care with each other or their physicians. They seem to think that “nature will take its course” or that “God” will make the decisions about when they die.

Combine this with physicians who practice defensive medicine and don’t have the time to sit with a family for the time it takes to explain alternative medical options, and you have the costly, heartbreaking, frustrating experiences that affect patients and their families on a daily basis in this country.

As families, we have to remember that the quality of our elder relatives’ lives is the most moral index. Dignity and comfort in our dying is really what we all want.

We must communicate with our families and choose a physician we feel listens to us and is comfortable discussing all alternatives.

Dear Reader: Thank you for your concise and sensible advice. As I receive such letters, I’ll continue to publish some of them. I will also give equal time to those readers who may disagree with my stance on quality-of-life issues.

In any case, we, as competent adults, need desperately to discuss such topics, because each one of us, sooner or later, will be involved in the very issues that concern me and other clear-thinking readers.

The situation is serious, complicated and involves, to one degree or another, knowledgeable and sympathetic medical professionals – not a Jack Kevorkian, but a primary care physician who is willing to withhold expensive, invasive and painful therapy and testing in terminal aged, often demented and exhausted old folks whose primary concern in life is that they yearn for a gift: a painless, dignified death.

Such patients often require more than a hands-off approach. In such instances, pain control with narcotics, extreme anxiety controlled with various medications and careful attention to personal hygiene are necessary.

I am certain that you, as a respiratory therapist and a vital member of the medical team, can help immeasurably to lessen the damage caused by the occasional nursing home that demands life support in order to fill beds, the inexperienced nurse or doctor who has yet to determine the patient’s wishes, a family member with a health-care proxy and the ill effects of the long-gone family member who suddenly appears and insists on life at any cost for his relative.