Despite your best intentions, don’t wait until “five minutes to midnight” to take care of your end-of-life plan.
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It’s a pillar of the RTD movement, that we treat our suffering pets more humanely than suffering friends and family members. “Let me die like a dog” has long been a call to compassion. The author went through the agonizing decision to “put down” a beloved canine companion, and he regrets not knowing what “Woody” would have wanted.
“Sleep deprivation amplified every emotion and wore me down quickly,” she said. She was exhausted, angry, and felt guilty. She was “flying blind” to be the surrogate as Betty neared death – and she was a trained, experienced hospice RN. What does that say about your chance of being an effective surrogate?
On the surface, continued passage of U.S. death-with-dignity laws appears favorable for the RTD cause. But the landscape is littered with potholes, land mines, and detours that raise more questions than the new laws address.
What happens when a devout person of faith – steeped for life in church doctrine that preaches the sanctity of life – must minister to dying patients who choose to exit with aid because state law provides that option?
Every U.S. state has laws against treating animals with cruelty. But only a handful permit Medical Aid in Dying to alleviate human suffering – and only in a small set of very limited circumstances.
What’s wrong with this picture?
As discussed in Part 2, the SPIKES framework is useful to explore the family’s understanding of their loved one’s illness and to share information about medical condition and prognosis. When the purpose of a family meeting is to discuss goals of care, it may be useful to “unpack” care goals using the REMAP framework.
Just as for any medical procedure, conducting a meeting with families of seriously ill patients requires training and practice. Practitioners must develop skills in structuring serious-illness conversations and responding with empathy in emotionally fraught situations.
Timely, well-conducted conversations about goals of care in serious illness are associated with improved outcomes, including care aligned with the ill person’s values, less unwanted (and often expensive) care, improved satisfaction with care, and fewer mental health consequences for patients and families.
Children have also experienced the death of close relatives, but it often happens that we try to hide death from children in a misguided attempt to protect them. Far from helpful, this confuses children and prevents them from handling the pain of the loss they have suffered.
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