While it may feel scary or overwhelming to think about our own deaths, asking yourself basic questions about how, where, and when you’d want to die, if given the choice, is a critical first step. Would you prefer to be at home or not? Would you want loved ones around you? Do you envision attempts to keep you from dying with resuscitation and life support measures or do you prefer a natural death? These are not easy questions to ask ourselves or conversations to have with our loved ones. But they are necessary ones if we want to leave this world on our own terms and ease the burden loved ones will face when it’s our time to go.
Unfortunately, the very people we expect to help guide us through these conversations are not well prepared. A recent national poll found that while almost all doctors think having end-of-life conversations with their patients are important, nearly half said they frequently or sometimes feel unsure of what to say and less than one-third reported having had any formal training specifically on talking with patients and their families about end-of-life care. Why is this the case? Because our medical culture default is set up first to keep people alive at all costs.
Conversations about how to die can be seen or feel as going in direct opposition to that cultural norm. So what can individuals do? First, consider identifying a legal surrogate decision maker. This person is someone you trust to follow your wishes at a time in the future when you cannot make your own decisions, even if challenging situations arise, like family tensions or unanticipated medical events. Any adult can serve as your surrogate regardless of whether they are related to you or not. Ideally, that person should be very knowledgeable about your values and wishes and formally accept the responsibility. Additionally, consider completing a living will or similar advance directive form. Although this shouldn’t replace conversations with loved ones or your legal surrogate, completing a living will can be a practical way to express your general values and wishes around life support and serve as a guide for loved ones and your healthcare providers. In some states, other documents like a Physician Orders for Life-Sustaining Therapies form may allow you to complete surrogate and living will designations together. Second, learn about palliative care. This specialized medical care focuses on helping seriously ill patients and their families and provides an extra layer of support to address symptoms and the stress of being ill during any phase of treatment. Talking to a palliative care doctor is appropriate at any age or stage of a serious illness. Typically, palliative care is available in most hospital settings and as a home health care service in many parts of the country. Finally, familiarize yourself with hospice, a specialized, interdisciplinary care option for those who are likely to die of a terminal illness in the next 6 months and are no longer pursuing curative treatments. It focuses on helping a person, and their family, live the best they can until they die. Death is inevitable, but how we die usually is not. Hospice can be provided at home, in a nursing home, and in an inpatient hospice setting; it is particularly important if you decide you do not want to die in a hospital. When ill, all roads lead to hospitalization and once in the hospital, many barriers can prevent a transition home to die. It’s important that loved ones and healthcare providers know your preference in advance. [emphasis added]
Muhammad Ali's funeral: We can't cheat death—but we can control how we die — Quartz: