End of Life Decisions

I think that nothing is more challenging for families, physicians and nurses alike as end of life decisions. I left out patients from that list, as I have found through the years that patients have the easiest time talking about death compared to the rest of us. The rise of hospice care in the United States, while purported to represent "Death with Dignity," which I think is appropriate and true, is also about helping physicians and families deal with death. The difficulties and confusion comes from trying to determine a patients' wishes as they relate to end of life. Is there a next of kin, a health care proxy, an advance directive, a signed Do Not Resuscitate/Do Not Intubate order? All of these questions, whether they are asked and answered, affect our ability to provide the appropriate care to the patient, and allow our physicians, nurses and families to feel comfortable in providing that care. I know it is cliche, but make sure you talk about it with your loved ones: what would you like me to do in this situation? Speak with your primary physician about it so that it is in your file. Let the hospital know; don't assume they do. We have the questions built into all of our admitting processes so make sure you use it each time you or a loved is admitted.