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As death draws near, patients and families face agonizing decisions End-of-life care
Deciding whether to fight for life at all costs, or prepare for death, is a heart-wrenching decision some patients face

Date published: 8/24/2008

IT'S BAD ENOUGH to be dying of terminal cancer, but when your medical specialists are pulling you in opposite directions, advising conflicting treatment plans, it generates more anguish and requires the patient and the family to make some heartfelt decisions.

A patient I'll call Mr. X already went through surgery and radiation therapy for his cancer. Now, unfortunately, the biopsy of the lump that recently appeared shows recurrence.

He is in the care of an enthusiastic, dare I say gung-ho, surgeon who is urging him to have surgery. But his oncologist, together with his daughter, is asking him: "Is another five years of life, but in a nursing home with a feeding tube, really what you want?"

In cases like these, quantity is pitted against quality. Stay alive at any cost, or prepare for the inevitable sooner with less intervention? It's a decision that can put a terrible strain on the bravest patient and most devoted of families and medical staff.


Sorry to confront you with the uncomfortable issue of dying here in the halcyon days of summer, but death is no respecter of seasons. And this case is a good illustration of what I am always telling my elderly, sick patients: That the time and mechanism of your death is not this inevitability, visited upon you by the almighty.

Rather, in this day and age, you can often have quite a lot of say about when and how.

In the old days it was easier. The patient had some terminal disease, the doctors tried every treatment they could, but the patient just died of "natural causes." The doctors felt OK as they had done their all, and everyone accepted it as a sad inevitability.

But that was before we clever doctors came up with so many life-prolonging treatments.

Now, it seems somebody has to be making god-like decisions about how and when the patient is going to die. And that can put a terrible emotional strain on everyone involved.


Controversy over what care should be administered --or withheld--goes both ways.

Organizations that provide help with a graceful exit and assisted suicide, such as Compassion & Choices (which now incorporates the Hemlock Society), and Final Exit Network, complain that people who ask their doctors for help "typically hit a stone wall."

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To learn about the various legal documents that can guide relatives and physicians in your dying days, see mayoclinic .com/health/living-wills/HA00014.

To download a copy of an advance directive that can be used in Virginia, go to caringin fo.org/stateaddownload. Or, search for "advance directive" on the Virginia Department for the Aging Web site, vda.vir ginia.gov.

Another resource is the National Hospice and Palliative Care Organization at 800/658-8898.