Deciding how it ends

31Jan11

Esteban’s uncle Cliff died this morning.

He was 85 and he’d been battling Alzheimer’s for a decade. So when he fell last weekend and broke several bones — and when he developed pneumonia a few days later, and when he lapsed into a coma yesterday — his family knew it was time to let Cliff go.

Cliff’s story could have taken a very different turn, of course. His children could have argued about his wishes; his doctors could have taken extraordinary measures. His life might have been prolonged. But at what cost, and to what end?

This morning I read a story about another 85-year-old who also has dementia. Among other ailments, Al Barnes has progressive kidney failure. His wife wants him to have dialysis. His doctors disagree, saying that it will be painful — and unwarranted, given Al’s cognitive condition. They may be able to prolong Al’s life … but at what cost, and to what end?

I can only imagine Lana Barnes’ agony as she clings to the hope that her husband can be saved, as her pleas to Al’s doctors fall on deaf ears. And I can only imagine the anguish of Barnes’ other loved ones, who don’t want their father and grandfather to suffer.

The case goes to trial on Wednesday. It’s strange to think that a judge will essentially be deciding whether Al Barnes lives or dies. But, according to the Star Tribune article, such end-of-life decisions are actually surprisingly common:

Nine of 10 deaths are preceded by families making decisions to halt some type of life-sustaining treatment, [said Dr. Steven Miles, a University of Minnesota expert in end-of-life care]. When disagreements arise, families and doctors usually resolve them within five days.

I’m relieved that, for Uncle Cliff’s family, the decision was clear (though far from easy). And I hope that Al Barnes’ case can be resolved in a way that preserves his dignity without prolonging his suffering.

For the rest of us, there’s a lesson in these two stories: As uncomfortable as it may be to contemplate our mortality, it’s important to make our wishes known. Do we want to be resuscitated? Which is more important: Pain management, or consciousness?

Ironically, I’ve had a blank health-care directive sitting on my desk for weeks. I think it’s time to finally fill it out.



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