FAQs, page 2

Isn't this inappropriate? Shouldn't all efforts be made to keep someone alive?
What is appropriate is allowing someone who is beyond medical rescue to have the best quality of life they can have in their final months, weeks and days. Subjecting them to futile care which may, in fact, be harmful, or have intolerable side effects, is not usually desired by the patient.

Doesn't Hospice deal with these issues?
Yes, they do. However, the end-of-life conversations are most effective when they take place early in the course of a terminal illness. It is these very conversations that often lead the patient into Hospice care.

Doesn't palliative care address these issues as well?
Yes. Palliative care deals with symptom control and is usually a part of the end-of-life conversation.

Does a family or patient ever change their mind about being kept alive at any cost?
Yes, with the help of a frank discussion of their prognosis. A truthful and empathic discussion regarding the patient's condition and prognosis go a long way in allowing the patient to decide the best course for himself. Sometimes, this includes the physician's assessment that the patient is beyond medical rescue, and that continuing medical treatment would be futile, and may create great discomfort and pain. What is essential is when, what, and how these conversations occur. It is critical to help the patient and family understand and appreciate their situation, and to share with them what additional medical treatment could involve, in a respectful and comforting manner.

Is this just about saving money?
There could very well be financial benefits, but that is not the main value and goal of end-of-life conversations. It is all about helping the patient with LIVING their final days, and bringing comfort to them and their family. Having as much quality of life in their last days is the most important goal.

Who is responsible for initiating the end-of-life conversation?
The patient's physicians are the first to appreciate the prognosis. Ideally, the medical team, including the physician, nurses, social worker and chaplain, would meet to discuss when, what to say, and how to start the conversation, and who is most appropriate to initiate the conversation. 

When does one initiate the end-of-life conversation?
It depends on the circumstances. If the patient is near death, the conversation with the family needs to take place immediately. If there is more time, the conversation should take place as soon as the prognosis is clear to the physicians. The conversation can not begin until it is clear what the patient and family have already been told, what they understand about the situation, and what should be known about the patient's personality, emotional state, and culture. These factors all affect how the conversation should be framed.

What should be included in the conversation?
The patient's medical condition and prognosis.
What the patient can expect his physical condition to be as time progresses.
What can be done to make the patient as comfortable and pain free as possible.
Asking the patient for feedback about what they have heard and understand, to make sure the patient has a clear, concise appreciation of their situation.