In his role as one of the staff physicians at the Senior Health Care Center at Crown Pointe, Dr. Joel Rich may see patients for a number of years. But there is one thing that is probably true about the relationship between Dr. Rich and his patients. He is likely to be their last doctor.

In that role he is required to consider things that other physicians may not, and most likely at the top of that list is what kind of care a patient wants as they near the end of life.

“This is a very difficult issue because most patients don’t want to think about it until the end,” said Dr. Rich. “But that conversation is very important, and it should include the patient, family, caregivers and the doctor.”

At the very least there should be some written advance directive or Five Wishes and a durable power of attorney, he said. An advance directive is a document that spells out how you want to be cared for if you are unable to make medical decisions for yourself. A durable power of attorney gives someone you designate the power to make decisions – including medical decisions – for you. Five Wishes is a commonly used form, now recognized in most states that look at these five issues:

  • Who you want to make healthcare decisions for you when you can’t.
  • The kind of medical treatment you want or don’t want.
  • How comfortable you want to be.
  • How you want people to treat you.
  • What you want your loved ones to know.

“Having at least one of these gives us some direction,” said Dr. Rich. “And with new, ever-changing technology, it becomes even more of a challenge for us if we don’t have a plan. With these documents in place, patients can be straightforward. Do they want comfort as the primary concern? Do they want everything done that can be done to live every day? There are so many variables. In reality, most people fall in between, and that’s why it’s so important to know their wishes.”

It may be that one of the biggest benefits of having these discussions and making sure these documents are in place is that it takes some stress off the patient, family, caregivers and doctors during a time when stress is already overwhelming.

“It eliminates guessing,” said Dr. Rich. “And it often removes a lot of futile care – the kind of care we know is not going to be curative – and the expense that goes with it. In fact without clear direction, we sometimes end up prolonging the dying process.”

The major consequence of not having these discussions and prepared documents is undue suffering. The result can often be a poor dying process with prolonged suffering. People are in pain, the quality of life is extinguished, and there is a loss of dignity.

“When we plan things go smoother, and there are better results,” he said. “When you don’t talk about end-of-life care, things are much harder for everyone, and it is unnecessary. I wish all my patients would ask me to have that conversation.”

By David Greenberg

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