How to Create Easier End-of-Life Transitions

Elderly woman praying with rosary for the health of sick husband


There are few things in life more traumatic than losing someone we love or facing the reality of our own mortality. So, it’s only natural that we do everything possible to postpone that anguish for as long as possible. With today’s advances in healthcare, we have more options than ever before to delay the inevitable. But, more and more, people are beginning to ask if treating someone who has multiple health challenges and is nearing the end of their life really makes sense.

Studies tell us that approximately 80 percent of Americans would prefer to die at home. Yet, according to the Stanford School of Medicine, nearly 80 percent of Americans end up dying in a hospital, nursing home, or other acute care setting. This had led to some physicians beginning to question the ethics of extending a life that is rapidly diminishing and if doing so is the best way to care for the lives they’ve sworn to help.

It’s an agonizing decision. Most people want to feel they did everything possible to prolong a loved one’s life. Guilt often arises after a loved one has passed and taking a proactive approach to minimize that remorse is understandable. Doctors are trained to do everything they can to cure their patients and very few are adequately trained in hospice or palliative care. The Institute of Medicine’s report Dying in America concluded that “people who indicate end-of-life care preferences [usually] choose care focused on alleviating pain and suffering. However, because the default mode of hospital treatment is acute care, advance planning and medical orders are needed to ensure that these preferences are honored.”

As the report says, because the default response for most families and doctors is to extend life, it’s very important for individuals to make their medical wishes known before a crisis occurs.

In New Jersey, the best way to make your medical wishes known is through Advance Directives. There are two kinds of Advance Directives – a Proxy Directive (sometimes referred to as a Durable Power of Attorney for Health Care) and an Instructive Directive (sometimes called a Living Will). A proxy directive is a legal document that names a person you choose to make healthcare decisions for you if you are unable to do so. This may be on a temporary (if you’re involved in an accident) or permanent (if you can’t make these decisions on your own because of dementia or other disease) basis. The person that you appoint is known as your healthcare representative and they are responsible for making the same decisions you would have made under the circumstances. An Instructive Directive is a document that explains to loved ones and medical personnel what your wishes are when it comes to your care, including if you want life-sustaining treatments (CPR, ventilator, feeding tube, etc.). In addition to these documents, you should have a conversation with your loved ones and your physician(s) about your wishes, so everyone knows and understands what you want. This way, not only will you get the care you want, your loved ones will be able to act with more clarity, sparing them unnecessary heartache.

Another form you may wish to consider is a Practioner Order for Life-Sustaining Treatment (POLST), which creates an actual medical order that is placed in a patient’s file and can be accessed by paramedics, fire departments, police, emergency rooms, hospitals and skilled nursing facilities. You can create a POLST by having a conversation with your health care provider.

The transition from life to death is one of the most difficult challenges we face, both for ourselves and for those we love. Proper planning and open communication can make it easier for everyone and help to ensure you’ll have the end-of-life care you want.

Categories: Caregiving, Senior Health