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END-OF-LIFE
ISSUES
Open communication, planning
help smooth life’s final path
By Marcia Levetown, MD, FAAHPM
No one wants to talk about dying.
It’s uncomfortable and inevitable, so why discuss it?
As a doctor who has dealt with death all of her professional life, last few months of their lives. The dying process can be as beautiful
I can provide a number of good reasons to engage in the difficult as a birth — enriching and healing — with proper planning. With-
conversations surrounding healthcare priorities. out planning, deaths are almost uniformly fraught with suffering
for all involved.
Bitter arguments, often creating life-long family rifts, are routine
in the absence of knowing what the ill person would have wanted. Few of us will die suddenly; most of us will live with a life-threat-
Caregiving family members often are emotionally and financially ening condition for 10 to 15 years before we die of it. We will ex-
bankrupt after providing care that the patient might not have perience the best and the worst that medicine has to offer. We will
wanted. The vast majority of the healthcare dollar is spent on treat- live with increasingly harsh medical interventions, surgeries and
ments that are not likely to help and often harm the patient in the medications that, over time, no longer protect us from disability,
12 San Antonio Medicine • April 2015
