People should create a personal directive, a legal document that appoints someone else to look after finances, health care, crucial matters.
EDMONTON — People today have different expectations of what health care can achieve in providing ethically sound and clinically appropriate care. Some even have the false mindset that with today's medical technology, they are immortal.
Both birth and death tend to happen with a lot of kafuffle. But the two concepts are not approached in the same way.
"We plan for birth, we take classes about birth, we talk about birth and, ultimately, despite all of that, the process controls us and we do not control it," said Dr. Irene Colliton, a family physician.
"So why is it that we don't plan for death?"
Colliton said that a strong relationship is central to all patient-doctor interactions. It helps open up dialogue on a number of important issues, including end-of-life decision-making.
Colliton, who has long been associated with the Grey Nuns Hospital, spoke at Covenant Health's conference on ethical decision-making in health care. The conference, called Great Expectations? was held June 16. Her session was called, So You Think You are Going to Live Forever!
"Certainly from a societal point of view, society promotes planning in most spheres of endeavour, but end of life is not one of these areas," she said.
Most medical school training is in acute care settings, and doctors tend to focus on identifying and treating illnesses. A forgotten factor is that every patient will die eventually.
"One of the things I talk to my patients about is that mortality on an individual basis is 100 per cent. Some people forget that, and it seems to them that somehow they can trick the Grim Reaper, and they will be here for a very, very long time."
Many conflicts in medical ethics are traceable to a lack of communication. Communication breakdowns between patients, health care providers, and family members can lead to disagreements. Many apparently insurmountable ethical problems can be solved with open lines of communication.
Colliton pointed out that family doctors are uniquely situated to establish and augment the doctor-patient relationship. Doctors should discuss changes to a patient's health, and help them understand what choices they have in their care.
"Our society tends to focus on youth and vitality. That forever-21 mentality is very pervasive. Doctors certainly get caught up in this too. Numerous improvements in nutrition and medical care have resulted in significant increases in life expectancy."
Today, people born into Canadian society have a life expectancy greater than 77 years. For someone who survives to age 50 with no chronic disease, life expectancy escalates to the high 80s.
Many patients have chronic conditions or diseases. The important question for both the doctor and patient is how this disease will look as it progresses. As a patient's health condition deteriorates, the doctor and patient should identify the goals of care and assess quality of life.
Even as their health deteriorates, "what most people are looking for is to maintain a quality of life. If you can discuss it from that point of view, then you approach being on the same page," said Colliton.
She asks her patients to consider preparing a personal directive, a legal document that appoints someone else to look after the patient's important matters, including their finances and health care. Her patients are encouraged to outline their goals for their care.
She also lists the potential complications of chronic disease, and what can and cannot be done if those complications occur.
"If you tell people that their mortality rate is 100 per cent, they will think you're pretty negative," said Colliton.
What about miracles? When exceedingly ill people are facing the end of their lives, this question gets asked.
"I do believe that miracles happen, but they are at the grace of God, and I don't think they are tied to the merit of the individual. I don't know how God decides who gets one."