Some of the most important — and most difficult — conversations
you'll ever have are about your wishes for end of life. Talking with
your loved ones is an important first step in making your wishes known.
But it’s also essential for your doctor to understand your priorities
for end-of-life care.
During a free health lecture held on Aug. 31 at the Boulder Jewish Community
Center, BCH ethics committee member
Jean Abbott, MD, and BCH medical director of quality and population health
Ben Keidan, MD, broached the topic of why you should talk with your doctor about your
final days and how to go about it.
"It's essential for both your family and doctor to understand
your priorities for end-of-life care. We want to take your wishes into
account, but we'll never know if you don't tell us," Dr.
Keidan told the crowd of 200 lecture attendees. "At the heart of
these kinds of conversations is finding out what matters most to you."
He added, "It's also essential to designate a medical power of
attorney who understands your priorities."
Not One, But Many Conversations
Many people avoid talking about end-of-life treatment because it's
extremely difficult to do. In fact, one study found that only 7 percent
of people have talked about what is important to them with their doctors.
Keep in mind that "the conversation" with your doctor usually
ends up being a series of conversations — all of which become easier
once you start. You can initiate the first conversation at your next wellness
or routine office visit. But you don't need to cover everything right
then. Later, you can schedule more lengthy discussions during what are
called advanced care planning appointments.
Another thing to keep in mind is that what matters most to you for end-of-life
care can change over time. So the conversation with your family and your
doctor needs to be ongoing.
"We aren't good at predicting what we might want in the future.
Life is uncertain and circumstances change, our values can change. That's
why it's important to keep having these conversations," said
How Do You Prepare Yourself?
As you get ready for your end-of-life conversations, start thinking about
what matters most to you such as:
- Who would you want to make medical decisions for you if you couldn't?
- What kinds of treatment would you want or not want (for example, resuscitation
if your heart stops, breathing machine, feeding tube)?
- How long do you wish to receive medical care?
- Where would you want or not want to receive care (at home, in a nursing
facility, in a hospital)?
- Do you want your doctor to continue to treat your condition aggressively
or back off if you are in a situation where recovery is unlikely?
- When would it be okay for your doctor to shift from a focus on treatment
to a focus on comfort care alone?
"There are no correct answers to these questions, but knowing your
limits can help your doctor tailor treatments that maintain your desired
quality of life," Dr. Abbott said. "Make sure these wants and
priorities are included in your medical record in case you're unable
to decide for yourself, as well as who should speak for you if you can't."
It's also important to express your fears and worries.
"I'm always struck by how many patients worry about receiving
too much or too little care. Talking this over with your family and doctor
can give them a better idea of what you would want," Dr. Keidan added.
Take the time now to plan for your future. Schedule an advance care planning
appointment with your doctor.
If you are a Medicare beneficiary, Medicare will cover an appointment for
advance care planning.
Click here to view PowerPoint slides from Drs. Abbott and Keidan's lecture on
“Talking to Your Doctor About End of Life Care.”