Choices to make before death

[Dave Paprocki]

Seriously ill people and their families may feel swept along by the fatal illness and the various treatments, as if they have no control over the events. Some people seem to prefer this sense of having no control because it relieves them of the responsibility of deciding what should be done. Other people prefer to determine all aspects of their care, sometimes even including the specifics of their funeral and burial.
Honest, open communication between patients and doctors about preferences for care at the end of life helps to ensure the best possible quality of life during a fatal illness. The doctors provide a candid assessment of the likely benefits of end-of-life treatments and their disadvantages, including effects on quality of life. People express what they do and do not want to experience. People have the chance to state their preferences for treatment, place limits on that treatment, express wishes concerning where they want to die and what they want done when death is expected, and decide whether they want to donate organs after death.
Typically, people who become seriously or terminally ill receive care from their regular doctor, with whom they may have a long-standing, trusting relationship. However, there are some exceptions. For example, some doctors may object to using terminal sedation or high doses of opioids to control pain. Both of these treatments can make dying more comfortable but have the potential to hasten death slightly (although they sometimes even help the person live longer). If a person prefers such treatments and their doctor cannot provide them, the person may choose to obtain medical care from another doctor.
Sometimes a hospice team can provide such care and coordinate care with the dying person’s regular doctor. Hospice is a program of care and support for people who are very likely to die within a few months. Hospice care focuses on comfort and meaningfulness, not on a cure. People can receive hospice services in their home or in a health care setting.