Question: When is it appropriate and how should I discuss end-of-life issues with a relative who has heart disease?
Answer: Discussing end of life issues is always difficult. These are topics about how aggressive we should be, what kind of therapies we should use, when should we go to comfort care. And it's really a discussion about whether we accept that someone's at the long end of an illness, and there's very little you can do to turn it around. And how can you make their final days or weeks or months ones that have dignity and for which they're treated with respect and for which all of their interests are served, but maybe not necessarily treated in a way that's going to take them to the ICU and put them on machines, and have them kept alive in ways that may not be aligned with their own goals and preferences. And these are always tough decisions.
I think, in a way, it's never too early to have these discussions about what people's preferences are around end of life care. In fact, the farther they are away from that, the more comfortable it is to begin to discuss these, because these are topics that are going to affect us all at some point, so this is really an important conversation to have.
At some point, you may be a surrogate for your relative, you may be the person who needs to stand in and speak for your relative because they're unable to provide that guidance because of how ill they are, and the best way that you can do that is to have an understanding of what they would want, how they think about this, and how they would want their care shepherded and navigated for them as you stand in as their advocate.
So, my recommendation to patients are to have the conversation. Make it not a threatening conversation, but a positive conversation about taking control of their care, and I think most doctors will welcome this kind of conversation and assist in this, and I think that if done in the proper way, it can be a relief for people who are concerned about this, but aren't sure how to raise the topic.