Physician Focus: End-of-life issues need attention

Dr. Prescott Lee

Physicians undergo years of education and training to promote wellness, cure illness, and preserve and protect life.

But we're also conscious of the inevitability of death. In recent years, we've been paying more attention to end-of-life issues. It's important for us to do so because it's important for our patients.

As a physician who specializes in geriatric medicine, I am acutely aware of how death and dying affect patients and their families. I am amazed when an 80- or even 90-year-old reports to me, after raising the topic, that he or she has never had a physician ask them about end-of-life issues.

End-of-life issues are never easy to discuss, but such a dialogue is critically important for families. Preparing for your final days, especially if the patient has a terminal illness, is prudent; to specify to family members what your end-of-life wishes are and to prevent confusion, regret or trouble within families. Preparation also provides peace of mind for you, knowing your wishes will be honored.

While conversations between family members are essential, talking with your primary care physician is also important. He or she needs to know what steps you wish to be taken or not taken should you find yourself in a critical medical condition or become unable to make decisions for yourself.

We all recognize the need for a will, to ensure that our possessions are left according to our wishes. But comprehensive end-of-life planning calls for additional documents. Here are the basics, courtesy of the Hospice & Palliative Care Federation of Massachusetts.

- Advance directives refers to instructions about your future medical care, should you become unable to communicate those instructions yourself. Such directives include a living will and durable power of attorney or health care proxy.

- A living will, sometimes called a "directive to physicians" or "declaration of health care," specifies the kind of life-saving or life-sustaining care you want or don't want in the event you become incapacitated or terminally ill.

- A health care proxy, or durable power of attorney for health care, designates a person of your choice to make health care decisions for you if you cannot do so for yourself. A health care proxy, legally binding in many states, ensures that your care will be consistent with your beliefs and values and that your final wishes will be fulfilled.

- If terminal illness exists, you should also include an examination of hospice and palliative care, a medical specialty dedicated to relieving the pain and suffering of patients and providing them with the best quality of life possible. Hospice and palliative care is provided when care changes from cure to comfort during someone's illness. It includes expert pain treatment, guidance with treatment choices, and emotional support for the patient and family.

Prescott Lee, M.D., is chair of the Massachusetts Medical Society's Committee on geriatrics, staff physician at Brooksby Village Retirement Community in Peabody, and attending physician and infectious diseases specialist at North Shore Medical Center in Salem. Readers should use their personal judgment when seeking medical care and should consult with their personal physician for treatment. Physician Focus is a public service of the Massachusetts Medical Society. You are welcome to e-mail comments to PhysicianFocus@mms.org.