Wednesday, August 19, 2009

End of Life Counseling

One of the more misunderstood provisions of proposed health care reform concerns end of life counseling. This is not a "death panel" to decide who lives and who dies.

The proposal is an attempt to do what doctors and families are often unable to do - have a rational discussion with terminally ill people about their wishes and give them facts to help them come to an intelligent decision on their own. We've all had dying relatives who obviously needed to talk to someone about what was happening to them. Usually the doctor, who has sworn to help people live, is reluctant to discuss the subject. The people who should be talking honestly with the patient, family members/loved ones, just keep saying, "Oh don't talk like that. You're going to be fine." Right?

I remember when my own mother was terminally ill. She desperately needed to talk about it and say her goodbyes. My father simply couldn't handle that sort of discussion, and I'm an only child so it was up to me. Mom and I spent most of every day together for many weeks as I helped take care of her and it was emotionally draining. She adored my husband and was very happy that he flew down to see her and say goodbye. They lived in Florida; once a day I would walk on the beach to pull myself together. During that time we drew closer than we had ever been and we had many long and deeply satisfying talks. When she died, she was at peace and ready to go.

I think perhaps families either convince themselves that the patient will survive because they can't come to grips with reality themselves, or they think the patient will be traumatized further by hearing the truth. Whatever the case, they need to realize the patient's real need to say goodbye. Hospice workers sometimes are able to help in this way; they do such wonderful work.

In short, end of life counseling helps not only the terminally ill person but his loved ones as well. No one is going to "pull the plug on grandma" or decide whether she lives or dies. The counseling is an attempt to make this inevitable time less traumatic for everyone.

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