The final decision

Thursday, August 27, 2009

Senator Ted Kennedy died from the complications of a malignant brain tumor on August 25, 2009, at his home surrounded by family. A seizure that occurred more than a year ago, led to doctors finding a malignant glioma of the brain, a non curable tumor than often causes death within a couple of years. But while death was inevitable, treatment with radiation and chemotherapy allowed Senator Kennedy to continue his work and enjoy family and friends.

In the last days and weeks of his life, presumable knowing his life was near its end, Kennedy tried to put his affairs in order. He asked the Massachusetts legislature to plan his successor in the Senate and it seems that he had direction for his personal decisions as well. He died at home, with dignity, surrounded by family and not technology.

End of life decisions are difficult for patients to consider because it means reflecting upon one’s own mortality. It is difficult because family members and friends need to be informed about those decisions and be willing to communicate the patient’s wishes to health care providers. It is why the health care debate about end of life conversations became a cause célèbre.

Effective conversations about end of life can’t happen at the end of life. These are issues that are created within each patient based upon their beliefs, moral fiber and personal experience. And the discussions need a guide, like a care provider, who can fairly present “what if” situations so that an informed decision can be made. The decisions that are made are not written in stone. Situations and beliefs change. Ultimately, any decision made about providing or withholding care happens at the time a medical action needs to occur.
This is where it gets tricky. Many patients make well though out plans when they ponder abstract philosophy, but change their mind in the heat of battle. A person, who is adamant that everything be done, decides that the pain and struggle of “everything” being done is inhumane and requests comfort measures only. Alternatively, a comfort or palliative approach can be rescinded if the patient decides more needs to be done.

If the patient no longer can make those decisions, they are too ill or are unconscious, a power of attorney for health care can be designated to help the care provider meet the needs of the patient, if and when the patient can no longer speak for themselves. That means that patients and families need to talk about topics that are uncomfortable, sad and for some, morbid.

It seems that Senator Kennedy, in his passing, has given us an opportunity. Unable to predict the future and the “when” of his death caused by terminal brain cancer, he was able to choose “where” and “how”…home and surrounded by family and friends. A dignified death that befitted a dignified life.

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