The Wisdom of Ruth Project, cont'd.

Why pay attention to this stage of life? 

When we leave this world, it is important that we leave on good terms with ourselves and our loved ones. Those last days need be honored by all involved, including the medical and family caregivers, and perhaps most importantly, the patient.  It is important that everyone help make those final days be the best possible for that person, that they fulfill the need for comfort, security, and even relief.  We need to help them, as a Maryland physician put so well, ”to have a better end” and, in the words of another physician, "to die well."  That is what Ruth taught us when, in her dying days, she helped her loved ones understand and appreciate that “dying is part of living.”

To enable a patient to die well, everyone involved needs to understand and appreciate their role.

It is important for medical caregivers (physicians, physician assistants, nurse practitioners, nurses, aids, social workers, and clergy) to understand when a patient is beyond curative care, so that treatment can be utilized to provide support and comfort to the patient.  Research has demonstrated that futile attempts to prolong a patient’s life are often harmful, can shorten the patient's life, create unbearable and/or painful consequences, and have a lasting, negative impact on the family after the loss of their loved one. 

The benefits of supporting a patient's desire to "die well" are countless. For example, patients at the end of life would feel more in control of their days and would have the time and opportunity to be surrounded by caring individuals who can bring them comfort and relief.  The reduction of unnecessary procedures significantly reduces health care costs. Families find support and comfort that their loved one’s final days were more about living than dying!

How do all the “players” involved ensure that a patient “dies well?” 

One critical component is having end-of-life conversations!   

Medical caregivers need to share the patient’s prognosis in a way that everyone truly understands the options.  This will enable the medical caregivers and the patient, as a team,  to create a plan of action that provides comfort and relief, and that allows the medical team to offer support and feedback.  To do this effectively, the medical caregivers need to appreciate what the patient and their family understand regarding the prognosis, what information the patient and family already have, what their wishes are regarding treatment going forward, and any consequences of those wishes.  Most of all, medical caregivers must fully understand the patient's concerns and needs.

It is imperative that the medical caregivers appreciate whether the patient and/or their family are in denial, scared, or at peace with the knowledge of their impending death, especially if the patient and/or their family wants to do everything humanly possible to be kept alive.  To insure an effective end result, caregivers need to identify when this conversation needs to occur as well as what needs to be shared and then what is the best and most effective way to accomplish such.