4 Questions to Guide End-Of-Life Decisions

Here’s a difficult question, one most people would rather avoid, but will likely find they cannot: How do you ensure that your loved one, when nearing the end of their life, gets the care they need and want?

Surely, Dr. Atul Gawande would know. After all, in addition to being a professor at both Harvard Medical School and the Harvard School of Public Health, a practicing surgeon at Harvard’s second-largest teaching hospital, and heading two public health organizations, he thinks deeply about the human aspects of medicine. That thinking has made him a staff writer for The New Yorker, the author of several best-selling books, and the recipient of a slew of awards for his writing on medical issues. Oh, and he is also a MacArthur fellow.

If anyone would know what to do when approaching end-of-life decisions, Atul Gawande would.

And yet, he found that he did not. Not when it came to guiding his patients, and not even when it came to caring for his own ailing father.

So he did what most of us cannot: he spent three years researching the matter. The result was a series of articles, culminating in a book called Being Mortal: Medicine and What Matters in the End.

What did he find out? Shockingly, it was that one should simply talk to the patient, honestly and compassionately, about what they want the end of their life to look like. It’s a conversation — or
a series of conversations — that happens far less frequently than it should.

Being Mortal is a book every mortal should read, but for the sake of expediency, we will distill Gawande’s into the short list of “a few important questions,” as enumerated in an adaptation of
his book, printed in The New York Times as an op-ed entitled “The Best Possible Day”:

1. What is the patient’s understanding of their health or condition?

Too often, it is too little. This may be because of cognitive decline, or because the family simply does not have the heart to tell the full truth to their loved one.

2. What are the patient’s goals if their health worsens?

Who could be blamed for trying to avoid this question? But if the patient is not cognitively impaired, it must be asked. Sometimes, the patient has already written an Advance Directive, colloquially known as a Living Will, stating what measures they want taken in case they are not able to speak
for themselves.

But end-of-life decisions are notoriously complex, and simple wishes, stated long before they will ever be implemented, may be relevant in the patient’s current situation. Dr. Gawande suggests that all these questions be repeated as the patient’s health condition evolves.

3. What are their fears?

Another question that is hard to ask — and often hard to hear the answer to.

4. What trade-offs they are willing — and not willing — to make?

If the patient is of sound mind, the answers to this and all the other questions must be honored.

The questions are hard to ask, but by asking them, Gawande says, the family can “often unlock transformative possibilities.”

The staff at Tower Lodge Care Center, in Wall, NJ, prides itself on ensuring its residents have everything they need to design the life they want. Call us at 732-681-1400, or by clicking here
to discuss how your loved one can live their best possible days.