We live in society where there is a little white pill to cure every ill. There are pills to make us sleep, some to wake us up, some to slow us down, and some to speed us up. As doctors, our mission is to save and prolong lives. As caregivers, the goal is also to prolong lives. But sometimes, we need to say goodbye.
End-of-life care is a major money drain in our current healthcare system. Those dying do need proper medical care. But often, what is provided instead is futile medical care. Not only is this care costly and useless, but often it just protracts suffering and pain.
As a doctor, one of the most difficult tasks I face is initiating discussions about a patient’s final wants and wishes. Doctors want to heal, but sometimes it just is not possible. We wish to give hope but not infrequently it is in vain. For this reason, it is imperative that doctors discuss end-of-life issues long before the patient suffers a terminal illness. In fact, most adults should draw up a living will so that their desires are known. Accidents happen every day. No one knows when they will wind up facing a life-threatening crisis or even an unsalvagable one. Unless there is a living will, the medical team will do everything to prolong your life. That is why in the news we see stories of patients who ended up in vegetative states. Death is one thing, but to spend years in such a condition is worse for many.
“Doctors want to heal, but sometimes it just is not possible.”
Decisions need to be made that when healthcare is futile, there must be a time to stop. Heroic measures in the face of brain damage from prolonged hypoxia is not care at all. Rather it is extending the inevitable, creating more suffering for the patient, and placing a greater burden on the family. It is a far harder decision to make to “pull the plug” than to just let the patient die gracefully.
Doctors must become comfortable initiating these talks with patients and their family members. And foremost before everyone should be the patient’s wishes. Doctors like to give hope. But we are also expected to give honesty. When no good outcome is possible, we need to be able to communicate this effectively. And not only doctors. This applies to the whole healthcare team that is responsible for the care of the given patient.
And the loved ones need to be open to these conversation. It is very hard not to make decisions based on love and emotion. If possible, a healthcare proxy should be named. This is one who safeguards the patient’s wants, even in the face of disagreement. Once a proxy is established, other members must step aside and not complicate the decision-making process. All to often, a person’s last moments in life end up in a family feud. Input is important from everyone. But the legal person should be allowed to carry out their role. It surely is not easy for them.
As people live to later and later ages in the US, we will see these end-of-life issues more commonly. Sometimes the best medicine is no medicine at all. Sometimes, we just need to allow our loved ones to quietly pass on and say our goodbyes.
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Dr. Linda Girgis MD, FAAFP, is a family physician in South River, New Jersey. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University and she was recognized as intern of the year. Over the course of her practice, Dr. Girgis has continued to earn awards and recognition from her peers and a variety of industry bodies, including: Patients’ Choice Award, 2011-2012, Compassionate Doctor Recognition, 2011-2012. Dr. Girgis’ primary goal as a physician remains ensuring that each of her patients receives the highest available standard of medical care.
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