Most people, and the vast majority of physicians, say we want to die at home, with pain care and our loved ones around us. Unfortunately, it often doesn’t work out that way.
As a nation, and as individuals, we Americans are pretty bad about managing end-of-life care, as Dr. Justin Sanders, a palliative care physician at the Dana-Farber Cancer Institute, points out in a recent article in the New England Journal of Medicine.
We’ve got to do a better job of preparing. According to Dr. Sanders, that means educating doctors to have these conversations, creating systems to have these conversations, and trying to change our culture to remove the barriers to these conversations.
It also means that we as patients need to always keep in mind that we’re not going to live forever. It’s likely that there will come a time that we don’t have the capacity to make medical decisions. I don’t know about you, but I’m going to make sure that my family knows my wishes before then.
Sound awkward? Sound a little scary? Of course it does. If it didn’t this problem wouldn’t exist. But Dr. Sanders points to a couple resources that may help get the conversation started:
The Conversation Project offers a “starter kit” to help families approach the topic.
Gunderson Health System, a large Midwestern health care provider, offers a 20-minute “Advance Care Planning” tutorial that you can access here.
And here’s one last thought from Dr. Sanders: Once you’ve had the conversation, make sure to revisit the topic when you are faced with a serious illness or with a terminal diagnosis. Your wishes when you were healthier may turn out to be different than your wishes when you’re really sick. Check in with your family and with your doctor at such turning points.
Have you had “the conversation” with your doctor and your family? If so, how did it go? If not, what’s holding you back?