End-of-life care: A difficult but necessary discussion

By Kelly Roncace, South Jersey Times

It’s a subject not many people are comfortable talking about, but it’s a conversation that needs to be initiated before it’s too late.

The discussion involves end-of-life care — the choices and decisions that need to be made when loved-ones become unable to make decisions themselves.

Dr. Niel Rosen, Ph. D., assistant professor at Rowan University School of Osteopathic Medicine in Stratford, recently participated in a panel discussion about advance care planning and end-of-life care in honor of National Healthcare Decisions Day.

The event began with a showing of “Consider the Conversation: A Documentary on a Taboo Subject.”

“Our hope was that the people who watch it will be inspired to think outloud about this,” Rosen said. “When we think about the fact that we’re going to die, we think privately and not outloud with others.”

Rosen said it’s important to understand a patient’s life goals when planning for end-of-life care.

He said, when given a life-limiting diagnosis, it’s important to decide what makes a “good day.”

“What are you willing to put up with to have a good day?” Rosen said. “If you could only have two good days a week, would that be enough?”

And if a loved one has been diagnosed with a life-changing condition, what is it that the person thinks of as a minimum goal of life?

“Is it getting up and being able to make yourself breakfast, or just getting up out of bed?” Rosen said.

Conversations like this can help to open up the discussion.

“It’s important to think about these things before the crisis occurs so you can take care of things first,” Rosen said. “Anytime is a good time to talk about this. It’s better when you’re healthier than when you’re not.”

Marianne Holler, D.O. and palliative medical partner with Samaritan Healthcare and Hospice in Marlton, said anyone who has a complex illness that can’t be cured, but needs to be managed to ensure the patient’s maximum quality of life should have this discussion.

“I usually ask two questions: One, what is your understanding of the present health condition,” Holler said. “That helps me to clear up any misconception they may have about what’s really happening.”

Next she asks about goals.

“This helps me guide them into realistic goals,” Holler said. “Someone may say, ‘Mom had a stroke and is on a ventilator, but right before this she was driving and taking the grandkids to the mall. Our goal is to get her back to that.’”

When this occurs, Holler has to tell the family that, chances are, their goals will not be achieved.

Rosen said decisions such as what to do if someone suffers a severe neurological injury or if going for a walk will be likely after certain medical treatments, are important conversations to have prior to illness or injury.

“If you had a severe neurological injury in which recovery is unlikely, who would you want to make decisions for you? You have to pick a proxy,” Rosen said. “With neurological trauma from accidents, most people have strong views of what they would want.”

He said when you pick someone to serve as your “proxy” — someone authorized to act for another person — it’s important to start having discussions with that person as soon as possible.

“First, ask that person if they have ever taken care of a spouse or parent while that person was dying,” Rosen said. “Ask them how it was and did it make them think about what they want or don’t want when they are dying themselves.”

Holler said sometimes medical treatment causes more harm then good, depending on the condition of the patient.

“If the burden overcomes the benefit, maybe it’s time to stop,” she said.

Rosen also said that sometimes, depending on a person’s diagnosis, the choices you have made don’t match the situation you may have been given.

“But if you know what is important to that person, those important things and goals, people can come together to try to achieve those goals,” he said.

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Date Published: Thursday, April 24, 2014 - 08:30
Source URL: South Jersey Times