Discuss your end-of-life decisions with your family and physician.
End of life. It’s not a topic we love to think about. And planning for it is generally not at the top of our priority list. However, taking that step helps ensure your wishes are honored and can alleviate your loved ones from having to make difficult decisions on your behalf.
People of all ages can and should complete advance directives that spell out end-of-life wishes, including a living will. For those with a life-limiting illness, a living will can provide a sense of control by putting into writing your desires concerning medical treatments in the event you can no longer express them. It is essential to discuss your medical wishes with the person you designate as your proxy, or Medical Power of Attorney. This ensures your plans are clearly understood and can be carried out with compassion and confidence.
When a doctor expects you to live a year or less, completing a Physician’s Orders for Life-Sustaining Treatments (POLST) form puts you in the driver’s seat. The exact name may be different in your state, but this planning tool is written with your health care team and signed by you and your doctor. It resides in your medical chart and empowers you as the patient by spelling out treatment levels for specific emergencies or conditions that may arise given your individual case. In contrast to an advance directive, which often designates general preferences, a POLST is intended to be specific and actionable, requiring no interpretation.
When the End Is Near
If curative treatments are no longer working, or you decide to terminate these measures, and doctors estimate you have six months or less of life remaining, hospice care can improve comfort and the quality of your remaining time. Hospice is designed to treat symptoms such as fatigue, depression, shortness of breath, anxiety, nausea and anything else causing distress so you can focus on the people around you during this important farewell. Even with many medical advances in worldclass hospice care, these treatments don’t always ease the pain that can be associated with dying. The individual patient and doctor should choose a course of treatment best suited for each situation.
Medical aid in dying — sometimes called death with dignity or physician-assisted dying — while controversial, is a compassionate option now legal in several states. Statutes in California, Colorado, Oregon, Vermont and Washington allow qualified terminally ill adults to voluntarily request a prescription medication to hasten their death. Patients must be 18 or older, mentally competent, diagnosed with a terminal illness leading to death within six months and must be able to self-administer and ingest the prescribed medication.
If you live outside one of these states, other options for hastening death include stopping a treatment option, not starting a treatment, palliative sedation or even voluntary stopping of eating and drinking. Of course, all of these choices will require support from your health care team and should be discussed openly and thoroughly with providers as well as family members. During this time, it is often hard for loved ones to make difficult decisions because they are already faced with grief, but you can spare them additional heartache by making your end-of-life care choices well known and legally documented before the time comes.