Tough Medical Decisions

An interesting observation I have made after the opening of the Palliative Care Unit has been the increased awareness of palliative care in general. We, the Palliative Care Consult Team, are getting more consults for patients with advanced illness to help those patients consider comfort care or discuss end of life care. Discussions about palliative care usually focus on a few key decisions people face as they come to the end of life. Several tough decisions families face are:

Should my loved one be a "Do Not Resuscitate" patient?
Should we start or stop artificial nutrition and hydration for my loved one?
Should my loved one, who is in a nursing home, be hospitalized?
Is it time to shift treatment goals from cure to hospice or comfort care?

This decision can be difficult for families of patients who have previously expressed the wish not to receive aggressive life support. In times such as these, I am reminded that I deal with end of life care every day but this may be new for these families.

I also try to keep the focus of the discussion on the patient, “What did your mother want to have happen in times like this? Another example is “Your mother had an active life before this event would she want to continue life as she is now?” Sometimes this will help redirect the conversation, sometimes it just takes time. These questions can help relieve the families concerns because the patient has already made the decision for them.

Are you or someone you know struggling to make tough decisions on behalf of a loved one? If you have questions about end-of-life care or palliative care, please call (817) 250-4929.

- Alvin Mathe, D.O.,
Medical director of palliative care