Tom Brokaw received dreaded news when he learned he had cancer in 2013. He recalls the experience in his book, A Lucky Life Interrupted. The diagnosis changed Brokaw, as one would expect, and prompted him to consider his wishes for the end of his life.
Like many of us, Brokaw started the conversation with his family. He even made it public in a TEDx talk with his daughter Jennifer, an emergency room physician who acknowledges that a phrase like “no heroic measures” can be too vague to be helpful when it's most important to know.
"Death and dying often can be a very uncomfortable topic to discuss," says Dr. David Shute, Medical Director, GreenField Health. "yet, having a conversation with our loved ones is an important and healthy thing to do--even when you're not terminally ill."
There are many tools available to facilitate the process, thanks to organizations like Oregon Health Decisions, which offers a free planning guide that takes you through the steps of preparing an advance directive, which allows you to express your wishes for care and life-sustaining treatments if you cannot speak for yourself and to authorize a health care representative to make health decisions for you in that case.
As Shute points out, while an advance directive enables you to direct future decisions about medical treatments, it does not give direction to medical personnel about what medical treatments can be used in an emergency. In that case, a POLST or Physician Order for Life Sustaining Treatment is necessary.
While an advance directive and POLST may seem to accomplish the same goal, they play distinct roles in end-of-life planning. "A POLST is a binding medical order signed by a physician that spells out the patient's wishes for medical interventions such as life support, artificially administered nutrition, and CPR," he explains.
Examining the need for a POLST is a worthwhile discussion to have with your clinician, he says, especially for older patients or those who are seriously ill.
"We strongly encourage our patients to examine their wishes for end-of-life care," says Shute, "for themselves, their family, and their health care providers, because then we can all be prepared and literally on the same page about decisions related to their care."
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I enjoy building rich patient-physician relationships that help people enjoy healthier lives. Helping my patients to manage illness is a critical physician role, but I get the most satisfaction when we focus on improving health.