Care at the End of Life

What kind of care can I expect at the end of life?

You can be assured that you will receive treatments to manage symptoms and keep you comfortable at the end of life. These types of treatments are known as palliative therapy. Palliative therapy can also help people manage symptoms of non-life-limiting conditions, such as rheumatoid arthritis. The goal of palliative therapy is to help people maintain comfort and quality of life, regardless of whether their disease is curable. Based on your preferences, palliative therapy may be combined with other treatments to prolong your life or to cure your condition.

At the end of life, care may be given at home or in a hospital or nursing home. You may also choose to receive care through hospice, which provides palliative therapy and emotional and spiritual support for people who are in the late stages of a terminal illness. Your doctor can continue to direct your care and guide you to other resources as needed. Family, friends, and health professionals may help care for you.

What issues do I need to consider at the end of life?

Ideally, you will consider many end-of-life issues while you are active and able to communicate your wishes. By making arrangements in advance, valuable time can be used for other important matters, such as spending time with loved ones or tending to and nurturing relationships.

Consider:

• The type of health care and medical procedures you want or don't want.
• Writing an advance directive that includes a living will and a medical power of attorney. A living will is a legal document that expresses your wishes for medical care if you become unable to speak or make decisions for yourself. It allows you to keep control over your medical treatment decisions at the end of life. A medical power of attorney (or durable power of attorney for health care) allows you to legally appoint a health care agent (also called a health care proxy) to make medical treatment decisions for you, not only at the end of your life but any time you are unable to speak for yourself.
• Whether you are interested in donating your organs. If so, you can complete an organ donor card, a witnessed document that states your desire to donate specific organs when you die. Many states allow you to designate your wishes on your driver's license.

It is important to communicate your feelings openly and clearly to those you love and to your health professionals. Making end-of-life care plans while you are still able may ease your mind and make your final days more meaningful.

Will I ever have to choose between palliative therapy and curative treatment?

In many cases, you can pursue curative treatment as you receive palliative therapy to help keep you comfortable. However, at some point you may want or need to choose which type of treatment takes priority.
Stopping curative treatment is an option when it is very clear that your illness cannot be cured. Focusing on pain relief and symptom management does not mean that you will not have access to your doctor or to

excellent care. Your doctor still cares about you and your illness and will not abandon you because you have decided to focus on comfort. Also, curative treatment or treatment to prolong your life remain options. If your condition changes, you can shift back to curative types of treatments.

How does culture affect the approach to care at the end of life?

A society's attitudes about the dying process help shape people's feelings about death and the kinds of treatments they wish to pursue near the end of life. In developed societies, death has evolved from a common occurrence to an event that many people try to avoid or escape.

In the past, death was visible and dealt with openly. A dying person was almost always cared for at home. Advances in medical technology have made death more removed from everyday life. People near the end of life are now cared for most often in hospitals or nursing homes. As a result, many people are less familiar and less comfortable with the dying process.

Aggressive medical interventions have prolonged life, even in the face of long-term (chronic) illness. As a result, some people view illness as conquerable and death as something that can and should be avoided as long as possible, at any cost, without regard to quality of life.

Consider your cultural background and feelings about death as you review your treatment options at the end of life. If you can discuss these issues openly with your loved ones, it will help them to understand and be familiar with your treatment preferences and to be emotionally prepared for your death.

(article by Amy Fackler, MA)