A recent locum at my general practise (who is worth a post in himself, but that's for another day) sent me a link to this article from The New Yorker, with a request for a response. The article itself is a discussion of how we manage end-of-life issues - it's long, but well worth reading, even if you don't think you're interested in the topic!
End-of-life issues are a difficult topic - emotionally charged and often polarising. I guess that's why we deal with it so badly - but it's so, so important. There are no easy answers here... no cookie-cutter solutions... every case - every person, every situation is different and answers must be found for each on their own terms and in their own time.
I think my grandparents were... lucky, perhaps? It doesn't seem like quite the right word, but what I mean is that they were spared excessive, invasive treatments and mostly spent little time in hospital. The slow degeneration of old age is not easy to watch, of course, but I believe they were cared for in a way that was appropriate for them and their needs and wishes.
Firstly, and briefly, there were some professional reminders in this for me - that sometimes medical treatment is not the answer. That, either way, good pain relief and symptomatic treatment are essential. And doctors sometimes need to just be more realistic!
But I found that the overwhelming message of this article was that we need to talk about end-of-life decisions. Doctors, nurses, health-care workers... and - more importantly - as parents, siblings, children, friends... we need to talk about what we want, and keep talking about it. Yes, it's difficult and confronting and we don't know how to raise the issue, but given the alternatives, how can we justify NOT doing it? Part of me knew this, and said "Of course we need to ask, duh" - but what this article pointed out for me was that it's not as simple as asking "would you like to be recuscitated?" That's not enough - we need to talk specifics: If this happens, what do you want us to do? What about if that happens? Would you like this treatment?
It reminded me that one day I will likely be confronted with these same issues for my own parents, and while I know that they have both written advance directives, I don't really know what they say - or what their scope is. I've never talked in detail to my fiancé or my brother about what they would want, or - for that matter - about what I would want. We're young, yes, and my parents are relatively healthy, so it will probably be a long time before we really have to confront the issue - but you never know. Better to talk about it now, while it's not in our faces and it's not so emotional. And keep talking about it - the answers change over time.
What about you? Do you know what your parents want? Your brothers and sisters? Your significant other? Your best friend? What Gawunde's article told me was to talk about it. Keep bringing it up, keep asking the hard questions. One day you'll probably be glad you did.
Thoughts, anyone? Did this article say something different to you? Do you have an experience or insight you'd like to share?
