“The goal is not a good death. The goal is having a life worth living all the way to the end.” Dr. Atul Gawande being interviewed on NPR’s “Science Friday” about his book, Being Mortal: Medicine and What Matters in the End.
Dr. Gawande writes for other physicians, but his words apply to families during difficult times of decision-making, as well. He’s not talking just about physical safety or even comfort; he’s talking about meaning.
In our mediation practice, Sig and I often see serious conflicts arise between aging parents and their children around numerous issues: Where parents should live, with whom, and what kinds of medical treatment they should receive. These conflicts become more urgent as a parent nears the end of life.
The problem, Dr. Gawande says, is this: “Safety is what we want for those we love. Autonomy is what we want for ourselves.” Often the parents prefer autonomy to safety. As mediators, our question is “How can we help these adult families find solutions that recognize the value of both?”
Dr. Gawande’s solution is startlingly simple: Ask the patient the right questions.
- What are his/her priorities for the life they have left?
- What is your understanding of your health?
- What are your fears and worries about the future?
- What are your goals for the rest of your life?
- What outcomes would you find unacceptable?
If Dad is worried about leaving his beloved dog Jack, then any arrangement for Dad to move will have to allow him to bring Jack.
If Millie’s goal is to finish writing her memoir, then her pain management may have to be in smaller doses than if she did not need to be mentally alert.
If Jeanne will find any level of pain unacceptable she may choose to be heavily sedated.
If Sam’s faith community is a primary source of support and social life, he will want to be near his church and arrange transportation to it.
Another person may want to try every medical intervention available in order to live as long as possible. If so, that’s what they should get.
If the parent wants desperately to stay in her own home, then whatever arrangements are made for in-home care should take the other concerns into account.
Any of these solutions can satisfy the children’s desire for appropriate care for their parents. Dr. Gawande says, “Well-being is bigger than survival and safety.”
President George H.W. Bush celebrated his 90th birthday by sky-diving! Appropriate care includes that which the elder decides gives meaning to his or her remaining life.
Do you agree?
P.S. Below a link to the interview mentioned at the beginning of this article.
Dr. Atul Gawande on NPR’s “Science Friday” on October 10, 2014
Carolyn Parr
Beyond Dispute Associates
202-359-6141
carolynparr@toughconversations.net
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