On Dying

Yesterday we discussed power of attorneys and wills. Today we continue with dying from a doctor’s perspective.

The speaker is a classmate during my engineer days who turned doctor, and had been practicing medicine since the late 70s. He has approximately 13,000 patients throughout his medical career, about 1/4 of which are seniors i.e. over 3,000. On average, he has to talk with 3 to 4 families every month and break the news to them that their loved one is not going to make it. Based on his extensive experience, this is what he suggested:
• With medical advances, doctors can virtually guarantee that dying would not be painful, through the use of morphine analgesics. So one of the fears of death i.e. pain, had been conquered.
• Families often avoid telling the patient the extent of his illness, or that there is no cure and he is not going to recover, for fear that it might trigger worry and anxiety. Often this is not necessary, as seniors are not afraid to talk about death. They know that everyone without exception must leave sooner or later. What they fear more is the unknown, not knowing what to expect, so talking about it brings the taboo subject out into the open and short-circuit the fear factor.
• The above is also backed by research. A survey of the residents (average age 87) at the several nursing homes he founded discovered that the great majority of residents preferred that when it is time for them to go, that there be no aggressive intervention to prolong their time on earth.
• In letting his patients know the severity of their illness and how much time they have, some have opted to suspend treatment e.g. chemotherapy, so that they can wrap up unfinished business such as seeing loved ones, visiting the old country etc. while they are still mobile. The quality of life becomes important when the duration is limited.
• One of the most difficult decisions for families to face is whether to start or end life support e.g. tube-feeding. Medically it is a form of treatment and not hard for the doctor, who is not emotionally involved, to decide based on the chance of recovery. However, it is extremely difficult for the family to decide as feelings become paramount. Therefore he strongly advised discussing with the patient to see what his wishes are before it is too late. Doctors have a right to refuse treatment when there is no hope of recovery, but will often go along with the family when they insist on aggressive intervention, in order to avoid lawsuits. This makes an open discussion a necessity and not something to be avoided.

While all of the above is very helpful, speaking as a pastor, the most important thing to share with a terminal patient is the gospel. Everything else is temporal, while getting saved is eternal. At the risk of upsetting the patient, I would ask for permission to share the good news. The rest is up to God and him. The Lord had been gracious and merciful, and had given me the privilege and the joy of leading quite a few to Him at the last leg of their earthly journey. Preach the Word. Be ready in season and out of season (2 Tim 4:2).

(To be continued)

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