End Of Life Discussions

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Here is an example of how to begin the discussion
I would like to speak to you in private about some important things concerning your father.   Based on our most recent assessment, I believe that his condition is very serious today.  From what you have told me about his usual health, it sounds like he has been quite frail for some time.  I am particularly concerned about the:

  • Nature of his previous medical problems and physical state
  • State of his usual mental function
  • His level of function and independence
  • His frequent hospitalisations recently

All of this suggests that he is someone that will not easily tolerate a sudden illness as the one he has now.
Although we are beginning urgent treatment to help him through this, I am sorry to say that you also need to prepare for the worst.  It is a real possibility that he may not survive this current illness or if he does, there will be a prolonged period of recovery and debility that will continue to leave him vulnerable to further complications that he may not fully recover from.
I am wondering if you have ever had the opportunity to speak to him about the possibility of this situation ever occurring?  Naturally, there are various treatments and procedures available that may or may not have the potential to improve his chances of pulling through.  But at the same time, none of them provide any guarantee of success and they also involve varying levels of invasiveness and some of them may increase his distress.   There are some critical treatments we have already given with minimal side effects like oxygen therapy, intravenous fluids and antibiotics.   However, there are other options like intensive care or major surgery that may only add to his suffering without significantly improving his chances.
It is possible that despite anything we do, he will continue to deteriorate to a point where either his breathing or circulation will abruptly fail.  Cardio-pulmonary Resuscitation in this situation is an option but as you might imagine it is highly invasive, can be quite protracted and in these particular circumstances usually will not work.
I know that the possibilities I have outlined are quite confronting.  He and you may not have had the opportunity to talk about them before.   I also appreciate that you may not have expected that it would come to this.  Many of us hope that our loved ones slip away peacefully and quickly but unfortunately some of us aren’t given this opportunity.  However, I think it is important to discuss this now in view of your father’s illness.
The most important thing is that all of us respect his wishes, his comfort and his dignity.  We want to minimise his suffering and would definitely not want to subject him to interventions that he would not have wanted in these circumstances.  In regard to this, I need you to consider his current quality of life and how he would have liked to spend his last few weeks or months.
Can I leave you now for a moment now to have this conversation with those closest to him and think it through?   I know this feels like a heavy responsibility but it is also a privilegedone.  I also believe you are the best person to make it because you have known him the longest.  The main thing you all need to try and do is to step into his shoes and consider what he would have wanted. How would he have wanted his last moments to be remembered, rather than what everyone else would have wanted for him or from him.
I will speak to you again shortly to answer any further questions that will help you make this decision. Remember that regardless of the outcome; I want to reassure you that we will try to make his comfort a priority regardless of the situation and that you will be kept regularly informed about our plans.

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