Death, Dying and the End of Life discussion

While this discussion is not centered around a specific book, you will certainly find many examples of how a primary care doctor supports patients and families in Jordan Grumet's new release. Please jump in with your own thoughts!

Here are some of my helpful hints for end-of-life care:

Ask questions of the patient to assure that he/she is "up to speed" before jumping into hard-to-swallow news and advice. Some doctors are really great at this, while others... not so much. Asking what a patient's understanding is of his/her current prognosis gives a clearer picture of what info is missing and how well he/she can comprehend what has already been shared.

Doctors who avoid jargon are so much more helpful than those who use it to cloak the meat of their tough stuff to deliver. Speaking as though each patient or family member is a third-fifth grader helps created clarity through the fog of raised emotions near the end of life.

I look forward to others' comments!

Hi all-I completed a lot of research on the right-to-die movement and end of life care decisions for the book I'm about to release. I'm not a doctor, but I feel like these decisions are crucial in our lives, and I'd be happy to talk about whatever the group is interested in

In particular, I found it interesting that the same drugs that are currently being outlawed for lethal injection are the same drugs frequently used for physician-assisted-suicide. It's a complicated issues, made more so by the emergence of state legislation and developments in other countries.

Anyway, I'd love to see where the conversation goes.

Thank you for your comment, Alex. I'm very interested in your book and your research, and I do agree: these decisions are important to think about proactively. These issues are evolving, and now is such a critical time in our cultural conversation about death and dying, our care decisions and our support of dignity at all stages.

Welcome to this group! Do you have any particular topics you'd like us to start as discussion threads? Feel free to suggest!

I think one of the most important things physicians can do is to have the talk about end-of-life issues early on. There's no need to wait until the diagnosis of a terminal illness has been made. Doctors should determine a patient's wishes for end-of-life care while the patient is still clear-headed and able to make decisions. Get the Advance Directive on record as early as possible--and, if possible, make sure all family members are aware of it.

Time magazine had an excellent cover article (Sept 2000) called "Dying On Our Own Terms." I still recall the opening lines of the article: "Dying is one of the few events in life certain to occur--and yet one we are not likely to plan for. We will spend more time getting ready for two weeks away from work than we will for our last two weeks on earth."

Thank you for your comments, Christopher. It is so hard for most people (in our predominant culture) to embrace the wisdom, let alone the necessity, of planning for the end of life. Physicians can be so helpful in changing this aversion by being matter-of-fact in their approach and by encouraging every adult to start such conversations with their loved ones, so that when the time does come (and we don't know when that may arise) they will be better prepared to assist us and follow our preferences whenever possible.

Has everyone been following the recent passage of the CA state bill 128? The assembly just passed it, and it's in its way to the senate. If it passes, the discussion around death with dignity in the US could take a major turn.

I live in CA and am following closely. The big question is: Will Gov. Brown sign it?

I hope he signs. My father--after he had a devastating stroke that left him paralyzed, unable to talk, and unable to swallow--legally ended his life by withholding food and water under the care of hospice. The hospice team was great, but, nonetheless, his slow death over 7 days due to dehydration was gruesome. I wish he'd had the option to end his life more quickly and painlessly. He would have taken that option. The end result would have been exactly the same.

Me too. I hope it goes through. This would be a big step to empower patients. I'm very sorry to hear about your father.

Thank you, Alex.

I'm very sorry for your loss, Christopher. Thanks to you and to Alex for your participation here. I too am eagerly watching the legislation evolution and how it will affect our end-of-life support systems throughout North America.

I've just recently joined this group. I, too, am very sorry to hear about your loss, Alex. In Canada, we have our Supreme Court ruling that Canadians have the right to doctor-assisted suicide.

Link to a February article below:
http://www.theglobeandmail.com/news/n...

With a new government just recently elected, this ruling will even have more support.

Some years ago there was a documentary show about how some Canadians had to go to Dignitas in Switzerland for such support. Now we have our own here, thanks to our Supreme Court.

Hi M.V., Welcome. I enjoyed the article you linked. Good to know Canadians have the option for assisted death if the end of life offers nothing but pain and suffering. I live in California, and as you may know a month ago California became the 5th state to allow assisted death for people who are terminally ill. I hope it's something that I or members of my family never have to use, but it's comforting to know the option is there if needed.