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Tips for how physicians can help their patients who are in the process of dying approach death with dignity, and the value of providing hospice care.
As doctors, we were trained to save lives. Yet, we are not so well-versed in helping patients die. It is second nature that we want to do everything possible to keep our patients alive as long as possible. The fact is all our patients are going to die at some point, and we can help ease that transition. There comes a point when further attempts to prolong life become futile, and we are just adding to the patient’s suffering.
In the US, approximately $365 billion is spent annually on end-of-life care, or ten percent of total healthcare expenditures. While some of this is essential, such as hospice care, much is spent on futile care. The Merriam Webster Dictionary defines futile as “serving no useful purpose, completely ineffective”. While we may be able to keep patients alive longer, such as using ventilators, it should be evaluated as to the endpoint. It is futile if the patient has no hope of recovery. We can keep patients alive artificially for months at the cost of hundreds of thousands of dollars while their loved ones watch them suffer, but it is futile if they do not recover.
How Can We Help Our Patients Die With Dignity?
- Be proactive. Start the conversation early, before an end-of-life situation arises. We should be asking all our patients if they have a living will and what their wishes are if the situation arises. This should be recorded on the chart.
- Listen to our patients. Patients will let us know when our care is too much. We see patients with cancer refusing further chemotherapy due to the side effects, while in our minds, we believe it can save them. Everyone has the right to decide for themselves.
- Alleviate symptoms. If the patient has pain, give pain medications. The opioid crisis is raging, but treating a dying patient’s pain is not going to contribute to it. Giving a patient dyspneic oxygen to ease their breathing difficulty is not the same as intubating them. We need to do everything in our power to make the patient as comfortable as possible.
- Acknowledge the caretakers. Caretakers have specific concerns and questions. Answer them as honestly and directly as possible. Allow the patient to spend time with them before ending futile measures. No one wants their loved one to go without a chance to say goodbye.
- Address spiritual concerns. If a patient asks a question, be mindful of their beliefs. It is not the time to pontificate on your own beliefs. Let them have time to seek guidance from their spiritual advisors.
- Be empathetic. It is a very scary time in a patient’s life. Some patients have large families at their bedsides. Some have no one. Try to put yourself in the patient’s situation and treat them like you would want to be treated.
- Get help. Hospice nurses do an amazing job helping dying patients. Enlist their aid as soon as possible so the nurses can develop a rapport with the patient. Don’t wait until the patient is at death’s door. Palliative care specialists also possess a great deal of knowledge and experience in helping patients during these times.
As doctors, we are key players in helping ease our patients’ suffering, especially during their death. Yet, many of us don’t do a great job during this critical point in a patient’s life. The most important thing is knowing what our patients want and listening to their needs. We may disagree with their decisions, which is OK if we honor their wishes. Suffering often proceeds to death, and we should use all our resources to ease that burden.
