When Is the Right Time to Say Good-Bye?

Jack Harrison, a lifelong smoker, had been diagnosed with fast-growing lung cancer. This was his third diagnosis in the last 10 years. He had a choice – treat the disease aggressively, which would cause numerous unwanted side effects, or manage the pain and focus on the quality of his life. Jack chose treatment. He died 11 months later. His wife, Joyce, regrets the decision, citing that Jack’s quality of life was greatly diminished and she would have preferred to spend half that time enjoying his company and having him enjoying life rather than spending his last days fighting against a disease that was very likely going to claim his life.

It’s one of the most agonizing facets of the human experience – having someone we love suddenly be taken from our lives or to face the inevitability of our own death. So, it’s only natural that we do everything possible to postpone that anguish for as long as possible. With today’s advances in healthcare, we have more options than ever before to delay the inevitable. But, more and more, people are beginning to ask if treating someone who has multiple health challenges and is nearing the end of their life really makes sense.

Studies tell us that approximately 80 percent of Americans would prefer to die at home. Yet, according to the Stanford School of Medicine, nearly 80 percent of Americans end up dying in a hospital, nursing home, or other acute care setting. This had led to some physicians beginning to question the ethics of extending a life that is rapidly diminishing and if doing so is the best way to care for the lives they’ve sworn to help.

It’s an agonizing decision. Most people want to feel they did everything possible to prolong a loved one’s life. Guilt is often an emotion that arises after a loved one has passed and taking a proactive approach to minimize that remorse is understandable. Doctors are trained to do everything they can to cure their patients and very few are adequately trained in hospice or palliative care. The Institute of Medicine’s report Dying in America concluded that “people who indicate end-of-life care preferences [usually] choose care focused on alleviating pain and suffering. However, because the default mode of hospital treatment is acute care, advance planning and medical orders are needed to ensure that these preferences are honored.”

As the report says, because the default response for most families and doctors is to extend life, it’s very important for individuals to make their medical wishes known before a crisis occurs. We’re currently in the middle of National Healthcare Decisions Week, which exists to “inspire, educate and empower” people to take action in making their healthcare wishes known.

In California, the best way to make your medical wishes known is through an Advance Health Care Directive. This is a legal document that names a person you choose to make healthcare decisions for you if you are unable to do so. (Some states refer to this as a Health Care Proxy or Power of Attorney for Health Care, which is the same thing.) It also allows you to make your wishes known when it comes to your care, including if you want life-sustaining treatments (CPR, ventilators, feeding tubes, etc.). Additionally, you should have a conversation with your loved ones and your physician(s) about your wishes, so everyone knows and understands what you want. This way, not only will you get the care you want, your loved ones will be able to act with more clarity, sparing them unnecessary heartache.

The transition from life to death is one of the most difficult challenges we face, both for ourselves and for those we love. Proper planning and open communication can make it easier for everyone and help to ensure you’ll have the end-of-life care you want.