Category Archives: End of Life Planning

Food, Feelings and End of Life Wishes

The New York Times has a recent article about Food and the Dying Patient. It talks about a patient with dementia who could no longer swallow. When they tried to feed her she aspirated the food into her lungs which was causing pneumonia. The doctors turned to the family to decide whether they wanted a feeding tube surgically put into the patient’s stomach to deliver nutrition.  In this case, the family felt as though not putting the feeding tube in was cruel, because she would be hungry.

The next day, my patient was wheeled down to the operating room for her feeding tube, then a few hours later wheeled back to intensive care. Over the next couple of weeks, her sister sat on a chair beside her most days, wearing the requisite paper gown and gloves for guests of patients with resistant bacteria from prolonged hospital stays. She sat off to the side, separated from her sister by tubes, bedrails and the bustle of activity around them.

The patients family thought they were doing the kind thing, but as the physician points out:

But contrary to popular belief, a feeding tube does not prolong life in a patient with dementia. It actually increases suffering. A stomach full of mechanically pumped artificial calories puts pressure on an already fragile digestive system, increasing the chance of pushing stomach contents up into the lungs. And surgically implanted tubes are a setup for complications: dislodgments, bleeding and infections that can result in pain, hospital admissions and the use of arm restraints in already confused patients. But maybe most important, the medicalization of food deprives the dying of some of the last remnants of the human experience: taste, smell, touch and connection to loved ones.

Prior to reading this article, I hadn’t thought about the possible down sides of feeding tubes for patients in this type of situation, where they would need the feeding tube until they died. (There are some cases, such as a person receiving radiation for cancer of the mouth or neck where short term feeding tubes are necessary and helpful.)

The thing I took away from it was that educating yourself on what the pros and cons of various procedures are at different point in an illness is vital. Thinking about scenarios ahead of time so that you can communicate your wishes to your family, and understanding the pros and cons if you are the person faced with making the decision are crucial steps in the process. Someone who may want a feeding tube for a short period of time to restore health, may not want one if it will simply delay death and possibly cause further complications or confusions in the patient.  The more information you and your family have about your condition and the suggested treatments the easier it will be to make decisions that are in line with your wishes.

Do You Need To Update Your Living Will?

A living will, also called an advance health care directive, is a place to lay out your wishes for medical care and treatment at the end of your life. The hope is that your appointed agents will make sure these wishes are carried out. You can specify things such as whether or not you wantContinue Reading

“Can’t We Talk About Something More Pleasant?”

My favorite New Yorker cartoonist wrote/drew a memoir of caring her for aging parents called “Can’t We Talk About Something More Pleasant?” It outlines their decline as their minds and bodies start to go. She talks about how no one wanted to talk about “the future” but still they had to keep walking towards itContinue Reading

When Should I Write My Will? A Lesson from House, M.D.

I was watching a rerun of House, MD last night. One of the main character doctors became severely ill over the span of a couple of days. Finally, in severe pain, he was going to be put into a medically induced coma with the chance he might not survive. At this point he feebly tellsContinue Reading

Will Your Family Honor Your Health Care Wishes?

When I work with my clients to help prepare their plans for what will happen to their things after they pass away, I also talk to them about making sure that we put a plan in place for what will happen to them while they are alive but incapacitated and need someone to communicate withContinue Reading

Hospice Home Opening in Hingham

The old Quaker Friends Home on Turkey Hill in Hingham is being reopened as a hospice facility this fall by Norwell VNA & Hospice. The Hospice Residence at Turkey Hill will have 12 beds in private rooms. According to the website: The focus of care is on providing physical, emotional, social and spiritual support forContinue Reading

The Importance of End of Life Planning

I thought about titling this post “We Are All Going To Die”… We can’t change whether or not we are going to die. We all are. Putting off talking about it or planning for it won’t make it not happen, but it could make it more confusing and painful for your loved ones. Seth GodinContinue Reading

Medical Orders for Life Sustaining Treatment (MOLST) v. Do Not Resuscitate (DNR)

Massachusetts has a few forms that people need to be aware of that affect their health care and the treatment that they want. When to use the forms can be confusing.  Below is a summary of each one and when you would want to consider filling it out. A health care proxy is a formContinue Reading

Leaving A Memo or Letter With Your Will

Your Will is the place where you distribute certain types of property after your death. Anything that has a joint owner (like a house or a bank account) or a named beneficiary (like a retirement plan or insurance policy) will pass to the joint owner or beneficiary upon your death. Your other property is distributedContinue Reading

End of Life Conversations Will Result In Your Death – 100% of the Time

Everyone is going to die. All of us. Some will die when we are young, some when we are old. Some will die a quick death, and others will linger while those around us try to figure out what to do. (I know, I don’t like it either.) So, when the discussions about the MedicareContinue Reading