An incredible book that I read in the past year was “Being Mortal: Medicine and What Matters in the End” by Dr. Atul Gawande. The book is a discussion of the state of American medicine as it relates to end-of-life care. Mr. Gawande argues that doctors often cause more suffering to patients by prescribing completely unnecessary procedures at the end of a person’s life.

Dr. Gawande would instead have us focus on our quality of life. His research and observations back his insights that people receiving hospice care are able to live with dignity and to die with dignity, and with less pain. Incredibly enough, people who choose hospice usually live JUST AS LONG as the patients who choose to continue their treatments. 

Yet this conversation is one of the hardest for a doctor to have with his patients. How do you tell someone that it is time to stop fighting and instead concentrate on your remaining months of life?

Most doctors are not trained to have this discussion. They are also afraid of future law suits from grieving children. So they prescribe all available treatments, regardless of whether these treatments have a good chance of curing the illness. These treatments are usually costly, painful, cause unpleasant side effects and are too-often completely ineffective.

This conversation is also very hard to have for an estate lawyer. Can you ask someone to decide what it is that is important to them at the end of life? How would they prefer to die – in a hospital, with tubes sticking out of them, or in their home at peace? At what point would they prefer treatments to stop – when there is 10% chance of a cure or when there is 2%? What is most important to them in life: To continue living with their mental faculties intact or to simply continue living, regardless of the condition? There are no right answers to these questions – they are completely dependent on the individual – and just like physicians, attorneys are not suitably trained to have this conversation with their clients.

It is clearly important to think about these end-of-life issues. Because if you don’t think about them and you do not write them down, then your relatives may end up making these decisions for you.  And unless your specific wishes were properly written down, your wishes may not be respected at all.