Reconsidering Your End of Life: Quality vs. Quantity?

By Richard M. Morgan

Over the years, ethics in medicine has become a more important topic. Medical science has found ways to enable people to live longer, but at what cost in quality of life, family time, and resources? One question that has been asked is, just because medical science can keep you alive for some additional months or so, do you actually want to undertake what this entails to achieve it? Do you wish to squeeze out every extra day even if this means being shuttled from home or facility to hospital over and over again, and to end up dying in an antiseptic hospital room hooked up to a bunch of wires and tubes? Or, would you prefer to live as well as possible, until enough is enough, at which point, you can go home to live out your remaining time with your loved ones in more comfortable surroundings?

In our society, you have the freedom to choose (with some legal limitations) with proper advance planning. An excellent article, entitled “The Ultimate End-of-Life Plan,” written by Katy Butler for The Wall Street Journal (WSJ) back in 2013 on the subject can be found on her website. For those with an interest in this very important topic, you should also read Butler’s new book entitled The Art of Dying Well, A Practical Guide to a Good End of Life.

Here are a few important quotes from a more recent (February 8, 2019) WSJ article, entitled, “Preparing for a Good End of Life: The best way to achieve a peaceful death is by planning ahead and enlisting the help of loved ones,” which was adapted from Butler’s recent book:

  1. “Advanced medicine is replete with treatments (ventilators, dialysis, defibrillators, feeding tubes, to name a few) that postpone death and prolong misery without restoring health. The default setting is often to provide them until the whole family unequivocally says, “No.” Get clear, long before that final panicked call to 911, on what gives your life joy and meaning. When you can no longer enjoy those things, what medical treatments would you refuse? Nobody can answer this for you. We vary widely in how much suffering we’re willing to endure for more time on earth.”
  2. “If you face a frightening diagnosis, ask your doctor to draw a sketch tracking how you might feel and function during your illness and its treatments. A visual will yield far more helpful information than asking exactly how much time you have left.”
  3. “If your doctor isn’t curious about what matters to you or won’t tell you what’s going on in plain English, fire that doctor and find another.”
  4. She tells a story about a woman who had stage-four inflammatory breast cancer. Her doctor prescribed an invasive set of procedures that “would have destroyed her quality of life without curing her rare, and usually lethal, variant of breast cancer.” Instead, the woman “engaged another oncologist who asked her, ‘What do you want to accomplish?’” She said “she was aiming for a ‘Niagara Falls trajectory’: To live as well as possible for as long as possible, followed by a rapid final decline.” She has now lived eight years without surgery, being hospitalized or going into debt. Instead of invasive procedures, she opted for daily estrogen-suppressing pills to slow her disease and an intense session of “palliative radiation” to minimize pain. During her time on earth, she has continued to live her life to the fullest to the extent she is able.
  5. “No matter where death occurs, you can bring calm and meaning to the room. Don’t be afraid to rearrange the physical environment. Weddings have been held in ICUs so that a dying mother could witness the ceremony, and dogs have been smuggled onto hospital floors. In a hospital or nursing home, ask for a private hospice room or “comfort suite,” get televisions and telemetry turned off and stop taking vital signs. You can turn a bedside table into an altar for flowers, family photographs or religious icons. Open flames are forbidden, but electric LCD ‘candles’ can create a sacred feeling…Hospital staff may help if you ask.”
  6. “There is a way to a peaceful, empowered death, even in our era of high-tech medicine. If you accept the reality of death and plan for it rather than fight it, you can restore dignity, community and, yes, even beauty to your final passage…That is not a promise it will be easy…But you don’t have to be a passive victim. You retain moral agency. You can keep shaping your life all the way to its end…”

No one can cheat death forever, but Butler has provided practical advice that could make a real difference in helping you achieve a much better end of life. Morgan + DiSalvo can further help by preparing Advance Directives as well as assist you through the Living Will portion of an Advance Directive. Call us today to set up a consultation – 678.720.0750.

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