The End of Life is Scary
An obvious title to a posting; but many aspects that aren't considered are particularly scary. I consulted with a patient who had very bad lung disease. His lungs were so bad that he could hardly get oxygen into his blood nor rid his body of carbon dioxide. The slightest extra problem, even something as little as a cold, could destroy his tenuously balanced condition and land him on a ventilator. Based on his condition, he would probably never be able to come off of this machine. That means he would never breathe on his own, and he could never eat or talk either.
He seemed to understand this, and told his internist (and me) that he would not want to be on a ventilator even if he were about to die. That is not how he would want to spend the last hours, days or weeks of his life.
When the time came, one of his children talked him out of it. He couldn't bear to let his father die, so he pushed until his father agreed to use the ventilator.
Whose decisions are these? Do we really let people make decisions that are best for them, or do we push them to make particular decisions that we believe should be their preferences? Are relatives without medical training able to work through the process of deciding about end-of-life care? Who is around to help at this crucial and scary time?
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