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Advances in Medicine Require Advance Care Planning
By Dr. Susan Tolle
Life and Death…Then and Now
Our attitudes about end of life issues have changed a lot over the years. In the early 1900s, people died one of three ways: childbirth, infection, or trauma. Half of the children did not live to celebrate their fifth birthday. People usually died very quickly. They could be well one day, perhaps have a horribly high fever for a couple of days, and then die within the week.
There wasn’t a lot of chronic illness so advance care planning, which involves making decisions about life-sustaining treatments, wouldn’t have made much sense. There was very little that medicine could do to help, beyond holding a hand and being present with someone while they died. And while that is still an important part of tending to the sick, there is now much more we can do – and sometimes that requires some extremely tough decisions.
Our Parents Have More Options than Ever Before
Advancements in medicine have brought us breathing machines, dialysis machines, advanced cancer treatments, and long stays in intensive care, often for people who have a very poor chance of recovery. Family members sometimes find themselves having to make agonizing choices for their dying loved one – and the burden becomes tremendous when they have no idea what that person would have wanted.
Today, the majority of deaths in the United States occur with the decision not to start a treatment – even more often than with deciding to stop a treatment. Sudden death from something like cardiac arrest or a car accident is actually the minority. About 75% of Americans die of advanced chronic illness that they’ve had for several years.
The wonderful thing is that now most people live long past their fifth birthday, and into their 70s and 80s and beyond. Many people enjoy excellent health most of their lives. But as they age and serious illness takes its toll, and people grow more sick and limited, there may be a point when they decide they don’t want that next round of chemo or to be put on a breathing machine. They may say, “I’ve had four different types of treatments. Each one has made me feel worse than the last. I’m glad I had this extra time. But everything you can do for me will make me weaker, and I’m ready to go home now and be with my family.” That is, if they can speak for themselves. But sometimes they can’t. And that’s when the absolute necessity of advance care planning becomes evident.
Having a Plan in Place Helps Everyone
Advance care planning – which includes legal documents that spell out the wishes of the patient regarding life-sustaining treatments should they become incapacitated – is needed in a way that it wasn’t in 1900. And we as a society and as adult children of aging parents need to learn new skills for the new job that is before us. If you haven’t yet, have a talk with your parents about making their wishes known and documented. And make sure you follow your own advice and take care of your own advance care planning, too.
It’s a Process
We’ve found that advance care planning is not usually a one-time event. Rather, it’s a process that changes over time as a person’s health changes. Be sure to update forms as needed.
Dr. Susan Tolle is the Director and Cornelia Hayes Stevens Chair for the Center for Ethics in Health Care at Oregon Health & Science University. She received her medical degree from the OHSU School of Medicine and her training in Internal Medicine at the University of California, San Diego. Dr. Tolle completed her fellowship in Clinical Medical Ethics at the University of Chicago.
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