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Starting a conversation about end-of-life interventions

A New York Times book review had an especially personal tone. The reviewer is living with an advanced cancer diagnosis and grappling with care decisions. 

The book “Extreme Measures: Finding a Better Path to the End of Life” raises some important questions. The author, Dr. Jessica Nutik Zitter, is a physician specializing in pulmonary/critical care and palliative care. She makes a nuanced argument against the typical I.C.U. approach

Breathing machines, feeding tubes and catheters 

Modern medicine is able to keep people alive much longer than ever before. A man or woman in a coma can be kept alive with a breathing machine, feeding tube and catheter. Deciding whether to remove machines can start arguments between loved ones and bring up the “what ifs.”

When are end-of-life treatments pointless? The answer to the question probably depends on your personal viewpoint. The default in medicine is what Dr. Zitter describes as a “heroic model of saving lives at any cost.” If technology exists, shouldn’t it be used?

In one example, Dr. Zitter tells of how “well-intention resuscitative efforts had crushed [the patient’s] cancer weakened neck bones, rendering him quadriplegic.” The 90-year-old ended up tethered to machines.

An side note is that research shows physicians are less likely than others to receive intensive care, because many choose do-not-resuscitate status. But DNR orders do not cover all life sustaining interventions. A grandmother in her 90s or 100s with a DNR may never have expected to spend years bedridden with a catheter and medication to control anxiety.

Advance planning for end-of-life care

In a previous blog, we discussed more in depth who makes medical decision, if you cannot. In Colorado, a Medical Durable Power of Attorney or Living Will can play an important role in your estate plan. These documents can also avoid the cost and time of conservatorship or guardianship proceedings as well. 

End-of-life treatment can be only tailored to meet your wishes when plans have been made in advance. Speak with an estate planning attorney, especially if you prefer to forego certain care.


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