In this episode I share my thoughts on how to approach the very difficult task of making an end-of-life decision about the treatment a loved one should receive. Many people are called upon to be decision-makers in these challenging situations and this episode serves as a guide for choosing the best option for someone we love.Download the handout below:
This episode is sponsored by Suzanne O’Brien and her training program for caring for others at the end of life at Doulagivers.com and by your generous donations on my page at Patreon.com/eolu! Join the team and receive special bonuses as a thank-you!
Thank you to all of my patrons and sponsors! Your support means everything to me!
Every day families are called upon to make nearly impossible decisions about the type of care a loved one should receive as they near the end of life. Here are some suggestions for how to navigate this challenging situation when there is no advance directive available for guidance:
Gather medical information from all healthcare providers involved in care
Ask direct questions:
What is the diagnosis and what complications have occurred?
What is the effectiveness of the recommended treatment?
What are the chances for recovery or improvement?
Are there side effects from the treatment or will it cause additional suffering?
What will happen if treatment is stopped?
What would you do if this were your loved one?
Get expert advice and guidance from a palliative care team if available in your hospital
Remember past conversations with your loved one that might give you clues as to his or her preferences for the end of life
Consider the statistics that most Americans prefer to die at home and most do not want aggressive treatment to prolong life in the face of an incurable condition
Ask your loved one for guidance by expressing your concern and your desire to make the best decision. Even though your loved one cannot verbalize, they can hear you – listen for any intuitive or “felt” guidance that might come to you about the best choice to make.
Be gentle with yourself and recognize that you have done your best in a challenging situation
Seek support from others outside your family
Tune in next week for another episode! Share this content with others who might it helpful and consider leaving a review on iTunes.
This 4-module course is like having your own personal consultation with an end-of-life physician (me!) who guides you through completing your paperwork one step at a time!
Check it out!
This podcast is sponsored through the EOLU donation page at Patreon.com/eolu. By contributing just $1 or $2 per month you can help support the podcast and the End-of-Life University Interview Series. If you become a supporter I will happily promote your book, website, cause or organization on a future episode of the podcast! THANK YOU to my latest patron Sylvie and to all current patrons!!
IN THE NEWS:
Facebook announces it will offer employees up to 20 days of paid bereavement leave and 6 weeks of paid leave to care for an ill loved one.
A study done by U of Colorado Anschutz showed that oncologists are reluctant to have conversations with patients about their prognosis and patients seem equally unwilling to discuss the difficult facts about their diagnosis. This demonstrates the need for better preparation for the end of life BEFORE the onset of a life-limiting illness.
Change Happens: How to be Prepared for the Ultimate Transition
What steps should you take now to be fully prepared for later life? I like to break them down into 3 categories: Paperwork, People, and Purpose.
Here are some suggestions for your own preparations:
Make sure you have completed an estate plan and/or will to protect your financial assets
Appoint someone to be your financial power of attorney AND a separate person as your medical power of attorney
Complete your advance directive (or living will)
Plan for your funeral and burial
Gather important documents, account numbers, passwords, etc. into on file where they will be accessible in the future (Check out the BE Ready Checklist for a list of all these documents you should gather)
Tie up “loose ends” in your life by practicing forgiveness
Make amends with the people closest to you
Say “I love you” whenever you have the opportunity
Talk with your loved ones about your healthcare wishes
Talk with your doctors (and also spiritual advisor or attorney if relevant) about your end-of-life wishes
Be prepared to care for an ill or dying loved one at home if that should become necessary
Think about your own sense of meaning and purpose in life–are you living life fully in each moment?
Practice being present in the moment by taking up mindfulness or using deep breathing
Recognize that your purpose is not really something you hope to accomplish in the future; it lies in how you live your life each moment
Face your fear of death so that you can fully prepare and then relax and enjoy all that your life offers to you
Click hereto download the End-of-Life Preparedness Assessment to see if you are ready!
Tune in every Monday for a new episode. Until the next time, remember:
What do you do when a family (your own or a patient’s) is crumbling due to unhealed resentments and irreconcilable differences? Find out now.
In today’s episode I’ll share my best tips for helping families move through conflict toward resolution during stressful times like the death of a loved one. I’ve had lots of experience with this work during my years as a hospice doctor so be prepared for a longer-than-usual episode!
My new course Step-by-Step Roadmap for End-of-Life Planning is almost ready for release (just a few days away as I record this!) The course is simple yet comprehensive and will help you examine your mindset, values, beliefs, and fears about death before you make decisions about your end-of-life healthcare. Go to eoluniversity.com/roadmap to learn more and sign up to be notified as soon as the course is released.
This podcast is sponsored through the EOLU donation page at Patreon.com/eolu. By contributing just $1 or $2 per month you can help support the podcast and the End-of-Life University Interview Series. If you become a supporter I will happily promote your book, website, cause or organization on a future episode of the podcast! THANK YOU to all current patrons!!
Managing Family Conflict at the End of Life:
Families facing the death of a loved one are particularly prone to be divided by the resurgence of old conflicts and resentments. Over my years as a hospice doctor I have seen many families split apart by their differences at a time when they most need to be united.
Most of these families had longstanding grievances that had been buried and ignored over the years, only to rise to the surface under the stress of a loved one’s death. Sibling rivalries, parental favoritism, divorce, and competition for inheritances are the most common reasons for these resentments. In addition many families are also divided over religious and political differences, which is an especially prevalent problem right now.
One of the important functions of hospice staff members and other end-of-life workers is to assist splintered families with healing and resolution of their conflicts, whenever possible. But sometimes we are called to assist our own families when challenges arise. Here are some tips for being a peacemaker for a fractured family:
Remain neutral on the issues of conflict. As much as possible leave your own biases, preferences and beliefs at the door if you hope to help resolve a disagreement. This will be much easier if you are not emotionally entangled in the conflict. But even if you are, you need to learn to become a “Witness” to the situation (a higher state of consciousness that allows you remain detached.)
Listen to all sides of the argument. Spend time with each person involved in the conflict until you can grasp their perspective. If you are part of the disagreement then at least try to understand the point of view of the others involved in the situation. As soon as you begin to understand how and why the others feel the way they do then you have taken a huge step toward reconciliation.
Avoid trigger topics. Political and religious differences may complicate family conflicts at the end of life but are usually not reconcilable. So it is best to “agree to disagree” about these points of view and set them aside so that the focus can be on healing other issues.
Be present. By staying calm and unemotional you can prevent the conflict from escalating into an all-out war. Practice mindfulness to help strengthen your ability to be present so that your own emotions don’t flare up when you are trying to help others.
Find common ground. As you listen carefully to the stories of each opponent in the disagreement you may recognize certain common threads–areas where they actually share the same perspective without realizing it. Gather these threads so that you can remind those in conflict that are some things they have in common. Help them untie around the things that matter most (like doing what’s best for their loved one.)
Learn the wishes of the dying loved one (if possible.) If you can still communicate with the patient you may find out that she has a wish for her family to reconcile. You can use this wish to help draw the combatants together in their desire to please and comfort the one they love. Let the patient’s wishes become a “magnet” around which the rest of the family gradually comes together.
Have patience. Don’t try to force a reconciliation by rushing into a family conference or intervention. Allow for some separation initially and let the gaps between individuals gradually begin to close.
The bottom line is that families who don’t wait until the end of life to resolve their differences have a much easier time negotiating the challenges of death and dying. But that’s not the case for most families. Most are left to rehash old sibling issues, betrayals, disappointments, and wounds during the last days of their loved one’s life when they should be sitting at the bedside offering love and comfort.
It’s not enough to get your paperwork done … make sure it’s done right!
In this episode we’ll look at several common mistakes people make when doing their advance directives–mistakes that could make it more difficult for their end-of-life wishes to be carried out. Learn how to get your paperwork right so you can relax!
This podcast is supported through the generous donations of listeners made on Patreon.com/eolu. When you donate just $1 or $2 per month I will thank you by mentioning your name on the podcast and promoting your cause!
Thank you to my latest patron: Jayne Boulton–I appreciate your support Jayne!
In the News:
An online article from Managed Healthcare Executive asks the question: Can Data Analytics Aid in End-of-Life Care Decisions? The author cites a recent study from JAMA that shows 70% of MD’s reporting that they have not been trained to have end-of-life conversations with patients and 73% of patients over the age of 65 have never had an advance care planning discussion with a doctor.
Medical data analysts have suggested that EHR’s might be useful to help health systems identify patients in need of end-of-life conversations. The article points out that current management of advance directives on EHR’s is poor since on average it requires clicks on 12 different screens to locate a patient’s AD, which takes 1.3 minutes–not fast enough in an emergency situation. In addition many patients at the end of life experience more than 3 transfers to different facilities and their paperwork is often lost in the process.
Much work needs to be done to help patients get their wishes met at the end of life! For that reason I have created a NEW online course to guide people through creating their advance directives, making them legal, and having conversations with loved ones and doctors about their wishes.
Join Dr. Karen Wyatt, the host of Death Expo, in this conversation with emeregency room physician Dr. Monica Williams-Murphy, author of the award-winning book It’s OK to Die. They will discuss Dr. Williams-Murphy’s mission “to create conditions in which people: plan ahead, make their peace, understand that it is OK to die naturally, and make educated choices which allow them to pass away peacefully and comfortably surrounded by those who love them most.”
In this interview you will learn:
the tragic consequences of being unprepared for the end-of-life
the factors that have contributed to our cultural change in attitude toward death and dying
how to prepare for the death of a loved one – understanding the physical changes associated with dying
how to make peace with death and let go at the end-of-life
what doctors need to know in order to offer better care at the end-of-life
Support this podcast and End-of-Life University Interview Series by donating at Patreon.com/eolu!