This is a tough subject. When is the right time to die? The question came up recently in a discussion with my mother. Her dear friend, Rose, is currently on life support. Rose is a breast cancer survivor of many years and was diagnosed with lung cancer about ten years ago. After a couple of surgeries and years of chemotherapy, a recent bout of pneumonia has left her unable to breathe on her own. Her daughters are awaiting a miracle that will bring her home and back to her old self.

My mother thinks Rose’s daughters should have already let her go. She is frustrated with the whole situation. Mom reports that Rose didn’t have an advance directive or a living will. When my mother attempted to discuss this with Rose, she would change the subject. Rose also doesn’t have a health care proxy. It’s hard to believe that a person who has been treated for years at a world-class cancer center managed to evade the discussion of a living will.

I’ve had the difficult discussion of end of life care with my mother. As her health care proxy, I know her wishes and will honor them when the time comes for her to leave this world. I wonder what it would have taken to get Rose to prepare for the end of her life. My state has passed a law requiring that hospitals present information about advance directives to each patient upon admission. But this wasn’t enough to prompt Rose to make decisions, despite her numerous hospital admissions.

Here’s some food for thought. As home care nurses and therapists, we care for patients facing tough decisions about their health and the quality of their life everyday. We have an obligation not only to our patients, but also to their families, and help them address issues of end-of-life care before it’s too late. Waves of Baby Boomers (me included) are now facing the aging process — the inevitability of chronic illness and physical decline. I know I’m part of a group that will be challenging to deal with. Many of us think that we’ll live forever! I worry that we will be even more reluctant to face end-of-life issues than Rose’s generation. This increase in the aging population, the group’s unique characteristics and the fact that a significant amount of Medicare dollars are spent in the last year of life may lead us to a ‘perfect storm.’ So the cost of not having a discussion with patients and your family will have a serious financial impact on everyone as demand on the healthcare system increases markedly.

The CHAMP Resource section has tools available to help you with your discussion about end-of life care. Click here and select “Palliative Care & AIM” from the ‘All Topics’ drop-down menu to see the tools offered in our Resource Library. Also, please let us know how you feel about this subject. Tell us about your personal or professional efforts by responding below.

And rest peacefully, Rose.

Debra Bertrand, CHAMP Facilitator