No one wants to be the bearer of bad news. Americans are a death denying society. We view death as the enemy and a failure: something to be feared and avoided. Like ostriches we hide our head in the sand to keep from addressing the fact that we are all going to die someday (just don’t let someday be today or of someone I care about).
While there are dynamics to dying from disease or old age, dying is also unique to each person. The closest we can get to determining a prognosis is months, weeks, days or hours. There are too many factors involved in dying to be so specific as to say 6 months, 3 weeks, or 24 hours. This inability to be specific and the individual uniqueness makes the job of addressing end of life issues all the more difficult.
I think the fear of telling a patient and or family that nothing can be done, that we are talking about months/weeks/days of life, keeps us healthcare professionals from saying just that. What if we say a person is entering the dying process and they aren't or don’t die when we think they will? What if we are wrong? Looking at the emotional pain we will have caused can keep us quiet.
A “safe” area of conversation can be found in Advance Directives, speaking of end of life before faced with end of life. Most medical facilities are now required to ask if Advance Directives are in place but it is more often than not hurried over.
It would be helpful for the patient, family and even the physicians if there was an Advance Directives “talk” before treatments are begun to hear from the patient what their end of life wishes are before they are actually at the end of their life. Having that conversation, physician and patient, before treatment would make it easier for the physician to reopen the door when treatment options are futile.
Something more telling bad news...
A Living Will and a Durable Medical Power of Attorney are the closest we can come to insuring we be allowed to live to the end of our life the way we choose. Have you written your yours yet? Need help? Go to the chapter on making a Living Will and a Durable Power of Attorney in THE FINAL ACT OF LIVING.
