Thursday, November 27, 2008

Let's Talk About Death

We were talking about code status last night, and how it's really terrible that families get forced to make decisions about life or death. I know it's not a cheerful Thanksgiving Day topic, but as usual it tied in to some patients I treated whose families made them "full code" at 90 years old with advanced dementia, diabetes, heart disease, emphysema, strokes, etc (and usually all of the above). It's too late at that point to ask the patient what they want, so we rely on the families to help us. Unfortunately, I think it's human nature for families to balk at this, or to balk at withdrawal of care discussions when the loved one got intubated and is now in a persistent vegetative state on the ventilator. Who wants to be the one who "killed" Grandma? Isn't that how we would feel, if we make the decision to pull the tube, or the patient is crashing and doctors ask "should we intubate, or let her go?" (Not in those words, but you get my drift).

How much simpler if patients told us in advance what they wanted?

Having already had this discussion last night, I was surprised to see the One Slide blog rally going on today, and decided to jump on the bandwagon. Go check out their website to learn more, and then have the discussion with someone. They call it "Engage With Grace". It's easy. We fear death so much in America that we forget that life has a 100% mortality rate. Death is not always the worst thing that could happen to us. Tell someone what you want done to you when you can no longer decide for yourself. And then listen to your family when they tell you the same thing. Then, it's no longer your decision--it's the patient's decision, which is where it belongs.

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