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Notes From a Recent Conference on the Reality of End-of-Life Circumstances

Notes From a Recent Conference on the Reality of End-of-Life Circumstances

| June 13, 2023


Financial Planning and the Reality of End-of-Life Circumstances

Financial & Life Planning is an essential aspect of our lives, extending beyond personal well-being to encompass the welfare of our families. It assumes even greater significance when considering our loved ones and our own end-of-life circumstances.

Personally, hearing directly from individuals grappling with end-of-life decisions and witnessing their profound impact was a poignant experience. There were moments when their words resonated with an underlying pain, diligently concealed, as they fervently sought to convey the gravity of the consequences and the various paths available.

Here are some key highlights that left a lasting impression: 


Statistics and Frailty at the End of Life

One in five individuals will ultimately breathe their last breath in an intensive care unit (ICU). 

The number of hospital deaths currently stands at 700,000 each year. Many agree that living or dying within the confines of a hospital setting is far from ideal. So keep in mind that there are options for some to stay home or go to a non-hospital environment.

Although advancements have prolonged our lifespans, the inevitability of death remains an inescapable reality for all of us, so planning as if it's going to happen is essential.

The Perspective of a Gerontologist Physician

There is a lesson here. One of the Gerontologist physicians specializing in end-of-life care shared that his experience with his grandfather's death influenced his career choice. He, like me, still gravitates toward his elders due to his experiences growing up. It was obvious from his demeanor that he deeply valued still being alive. He reminded me of the mortician at a family wedding who enthusiastically took to the dance floor, reveling in the present moment.

Shifting Focus and Realistic Hope

He expressed the importance of shifting the focus from the inevitability of death to celebrating and honoring the lives of individuals. While acknowledging the sadness of witnessing people's passing, he emphasized that hope should be rooted in a realistic understanding of the situation rather than solely relying on finding a cure.


The Question of Hope and Acceptance

The question arises: Why do we hold onto hope? It stems from our desire to prevent pain and suffering. However, it's crucial to recognize that pain and suffering are part of the human experience. While we can reasonably minimize them, excessive treatment can have negative repercussions. It's natural to want to postpone the impending pain, but our aim should be to maintain a realistic perspective and avoid exacerbating the situation.

Emotional Weight and Shared Understanding

As one ICU nurse shared her experiences, the weight of what I assume are countless painful stories seemed palpable in her words. It became evident that the emotional toll of witnessing such situations is immense.

Shared Wishes and the DNR Order

The desire to prevent loved ones from suffering is widely shared. With this shared understanding, it is crucial to take a collective breath and collaboratively determine the best course of action, considering the inevitability of the situation if it becomes dire. However, it is essential to remember that 92% of people do not wish to undergo painful interventions to prolong their lives when it's their time.

Humor, Perspective, and Planning

Interestingly, dark humor can often provide a coping mechanism in such challenging circumstances, offering some relief and laughs amidst the morbid gravity of the situation.

Aging, Weight Gain, and Indulgence

Aging often comes with the benefit of encouraging weight gain, as losing weight is often associated with frailty and decline. So, if you want to gain weight and indulge in chocolate cake for breakfast, lunch, and dinner, many healthcare professionals believe it's perfectly acceptable!

Hospice Care as a Personalized Option

Hospice care should not be seen as a death sentence. It provides attentive and personalized care aligned with your values and fully informed preferences for end-of-life care.



Letting Go and Small Things at the End of Life

It's important to remember that if most things we once enjoyed are no longer available, it's okay to let go and stop eating and drinking. While this decision may evoke fear, it is a common part of the process for individuals who have lived a full life and are ready to say goodbye.

Difficult Choices and Individual Preferences

One speaker shared a poignant story about their father, who had to choose between the likelihood of having a stroke or bleeding out. Both options sound tragic, but he was on the verge of passing away in his specific situation and chose the virtually painless option that was best for him.

The Reality of CPR and Do-Not-Resuscitate Orders

CPR (cardiopulmonary resuscitation) has a success rate of only 12% in the general population. When administered to someone already seriously ill, it can be incredibly traumatic for the medical staff and the individual. Only 1-2% of people who receive CPR in a long-term healthcare facility can ever recover enough to leave.

Acceptance and Conversations About Impermanence

It can be difficult for families when faced with a loved one who has a do-not-resuscitate order, and they desperately try to delay the pain of losing them. However, it's essential to understand that the person is already in the process of dying. Bringing them back to life through resuscitation probably will not change their path. Healthcare professionals will honor the wishes stated in the order but aim to avoid making the situation worse and causing more pain and suffering.

The Impact of Dementia on Identity

The brutal reality for some individuals with memory loss at the end of life is that dementia makes them feel like they didn't have a life. It is a heartbreaking experience that highlights the profound impact of this condition on a person's sense of self and identity.


Perspective: Embracing Life and Having Conversations

In the grand scheme of things, it's unlikely that anyone will remember us or the things we did after 150 years. Some may find this notion scary, but others find it liberating. It's a reminder to live life to the fullest, to stop stressing over trivial matters that won't hold much significance in the course of a lifetime. Now is the time to make the most of every moment.

Hospice: Choice, Graduation, and Regret

When it comes to hospice care, it's essential to know that it's not a one-way street. You can try it and decide it's not the right fit, or you can even graduate from it if your condition improves. If you feel that the care provided is not meeting your expectations, you have the right to find another option that suits your needs better. Statistics have shown that many people who receive hospice care actually live longer and experience a better quality of life. The hospice expert they had shared that they had never encountered someone who regretted signing up sooner. Instead, many regret waiting too long to seek the support they need.

Conversations, Acceptance, and the Gift of Ease

At the end of life, small things can take on immense importance. Conversations about your desires and preferences become significant. It's crucial to have open discussions about what you want and what you don't want, ensuring that your wishes are understood and respected. By being open and comfortable talking about end-of-life matters, you can also help others. Discussing it more often, treating it as a normal conversation, is like exercising a muscle—it becomes easier over time. Remember, it is perfectly acceptable to have these discussions at any time.

Introduction to the Death Deck

Below are some of my favorite cards from the Death Deck to help try and facilitate some of these tough conversations. While I'm not convinced handing a dying person this deck is an automatic positive, you might find some tidbits that make you think or are worth sharing.