End Of Life Care

Making decisions for a loved one or ourselves about end of life care can be difficult and emotional. The one area that most of us avoid planning is the end of our life. Yet, if we don't at least think about it and share our ideas with those we love, others take over at the very time when we are most vulnerable, most in need of understanding and comfort, and most longing for dignity.

Big issues confront us when we think about our own death or that of someone we love. Our attitudes and beliefs about religion, pain, suffering, loss of consciousness, and leaving behind those we love come into play. We can let things unfold as they may, and for some of us that's exactly right. For others of us, it is good to plan.

How to Begin

Begin simply with yourself. Try to confront and understand any fears you might have: do they relate to the possibility of pain? Loss of dignity while undergoing treatment? Not being clearly understood by those around you? Being alone? Being overly-sedated or in a lingering state of unconsciousness? Leaving loved ones or unfinished projects behind? Leaving your loved ones without adequate financial resources? Dying in a strange place?

Once you know that you want to explore these topics and make some plans, most experts suggest that you begin by talking. Talk openly to family and friends about your values and beliefs, your hopes and fears about the end stage of your life and theirs. Someone who is uncomfortable with the subject can be led to talk with indirect topics. Use "openings" in conversations, such as recalling a family event and talking about a future event where you might not be present. Talk about whom you wish to leave a possession to, whom you'd like to have near if you were seriously ill.

Ask your doctor for a time when you can go over your ideas and questions about end-of-life treatment and medical decisions. Tell him or her you want guidance in preparing advance directives. If you are already ill, ask your doctor what you might expect to happen when you begin to feel worse. Let him or her know how much information you wish to receive about your illness, prognosis, care options, and hospice programs. Discuss with your lawyer and/or financial adviser whether your legal and financial affairs are in order. Talk to a religious adviser about spiritual concerns.

What do you need to talk about?

Specific issues relate to the end of one's life.

They include:

 Whom do you want to make decisions for you if you are not able to make your own, both on financial matters and health care decisions? The same person may not be right for both.

 What medical treatments and care are acceptable to you? Are there some that you fear?

 Do you wish to be resuscitated if you stop breathing and/or your heart stops?

 Do you want to be hospitalized or stay at home, or somewhere else, if you are seriously or terminally ill?

 How will your care be paid for? Do you have adequate insurance? What might you have overlooked that will be costly at a time when your loved ones are distracted by grieving over your condition or death?

 What actually happens when a person dies? Do you want to know more about what might happen? Will your loved ones be prepared for the decisions they may have to make?


A number of excellent resources are available to help you understand and plan for end of life care:

The AARP webstie offers information and helpful links for such information as:

 Estate Planning
 Financial Powers of Attorney
 Hospice For End Of Life Care
 Living Your Final Days To The Fullest
 Talking About Your Final Wishes
 Wills

A compilation of resources that enable and empower individuals to counter pain, isolation, and loneliness, and to help with other aspects of advance planning in life’s final months:

The Denver Hospice…as the region's leading hospice since 1978, The Denver Hospice provides an unprecedented level of expert, comprehensive and personalized care. From programs to promote comfort and manage pain, to counseling and support for families and friends.

The Colorado Collective for Medical Decisions (CCMD) provides knowledge that will help families and caregivers talk to each other and to health care professionals during times of such emotional stress. This is a link to information excerpted from three pamphlets created by CCMD with funding provided by The Colorado Trust. The pamphlets explain Tube-Feeding, Mechanical Ventilation and Cardiopulmonary Resuscitation (CPR) - issues everyone needs to understand to make informed decisions in the face of serious medical illness.

The Five Wishes document helps individuals express how they wish to be treated if they are seriously ill and unable to speak for themselves. It is unique among all other living will and health agent forms because it looks to all of a person's needs: medical, personal, emotional and spiritual. fivewishes@agingwithdignity.org




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