In 40 years of practice, I have seen how the final moments of one’s life can be inspiring or agonizing, no matter the manner of death. As I see it, the fear of death is a greater enemy than death itself. This has brought me to make the following recommendations for approaching our final moments.
Scientific advances, along with health care providers’ driven desire to save lives, have wrought lifesaving techniques that sometimes cause suffering (an unintended consequence). To correct this, making an advanced directive (living will) can help prevent great suffering. Going without is like arriving at the airport with no plans as to where you are going. Remember, a written advance directive is a tool to encourage discussions about end-of-life expectations. When you reach your end-of-life situation, do you want antibiotics, intravenous (IV) fluids, feeding tubes, resuscitation? (I don’t.) Speak to your family members about your wishes now in case you later lose your memory and ability to speak for yourself.
Also, there has been a growing emphasis and payment for hospice and palliative (comfort) care. Why not welcome these added financial benefits from Medicare and insurance if you or your family member qualifies? (These you control and can be stopped at any time.) When death is imminent, comfort care can be a blessing as it brings less emphasis on intervention which might cause suffering. Talk to your doctor and family about your choices.
When a person has a terminal condition, is no longer wanting or able to take oral feedings or fluid, I see it as cruel to force artificial fluids through IV or feeding tube means. Without fluids, the patient’s internal pain relievers (endorphins) turn on while setting the stage for living only about 10more days. Dehydration does not cause suffering. Considering the prolonged suffering that can result from artificial fluids, dehydration can be our friend.
As we get closer to our own time of death, it is prudent to say to those who matter, this wisdom phrase, originating from Hawaii, called “Ho’oponopono,” and made popular by Dr. Ira Byock. “I am thankful for you, forgive me, I forgive you and I love you.” This can help restore harmony with others and with oneself.
Bottom line: The fear of death can keep us from making important plans for an advanced directive and hospice, can trap us on a feeding tube and can keep us from finding harmony with the ones we love. A good death requires the courage to be prepared.
Richard P. Holm, MD is founder of The Prairie Doc and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc a medical Q&A show streaming on Facebook and broadcast on SDPTV most Thursdays at 7 p.m. central.