{"id":1006,"date":"2016-09-24T02:09:04","date_gmt":"2016-09-24T02:09:04","guid":{"rendered":"http:\/\/emedsa.org.au\/CoreMed\/?p=1006"},"modified":"2016-10-17T09:41:01","modified_gmt":"2016-10-17T09:41:01","slug":"end-of-life-discussions","status":"publish","type":"post","link":"http:\/\/emedsa.org.au\/CoreMed\/2016\/09\/24\/end-of-life-discussions\/","title":{"rendered":"End Of Life Discussions"},"content":{"rendered":"<p><a href=\"http:\/\/twitter.com\/share?url=http%3A%2F%2Femedsa.org.au%2FCoreMed%2F2016%2F09%2F24%2Fend-of-life-discussions%2F&amp;count=none&amp;text=End Of Life Discussions - CoreMed\" class=\"twitter-share-button\">Tweet<\/a><\/p><p><em>Here is an example of how to begin the discussion<\/em><\/p>\n<p>I would like to speak to you in private about some\u00a0<b>important<\/b>\u00a0things concerning your father. \u00a0 Based on our most recent assessment, I believe that his condition is\u00a0<b>very serious<\/b>\u00a0today.\u00a0 From what you have told me about his usual health, it sounds like he has been quite\u00a0<b>frail<\/b>\u00a0for some time.\u00a0 I am particularly concerned about the:<\/p>\n<ul>\n<li>Nature of his previous medical problems and physical state<\/li>\n<li>State of his usual mental function<\/li>\n<li>His level of function and independence<\/li>\n<li>His frequent hospitalisations recently<\/li>\n<\/ul>\n<p>All of this suggests that he is someone that will not easily\u00a0<b>tolerate<\/b>\u00a0a sudden illness as the one he has now.<\/p>\n<p>Although we are beginning\u00a0<b>urgent treatment<\/b>\u00a0to help him through this, I am sorry to say that you also need to\u00a0<b>prepare for the worst<\/b>.\u00a0 It is a real possibility that he may not survive this current illness or if he does, there will be a prolonged period of\u00a0<b>recovery and debility<\/b>\u00a0that will continue to leave him\u00a0<b>vulnerable<\/b>\u00a0to further<b>\u00a0complications<\/b>\u00a0that he may not fully recover from.<\/p>\n<p>I am wondering if you have ever had the opportunity to speak to him about the\u00a0<b>possibility<\/b>\u00a0of this situation ever occurring?\u00a0 Naturally, there are various treatments and procedures available that may or may not have the potential to improve his chances of pulling through.\u00a0 But at the same time, none of them provide any\u00a0<b>guarantee<\/b>\u00a0of success and they also involve varying levels of\u00a0<b>invasiveness<\/b>\u00a0and some of them may increase his\u00a0<b>distress<\/b>. \u00a0 There are some critical treatments we have already given with minimal\u00a0<b>side<\/b>\u00a0<b>effects<\/b>\u00a0like oxygen therapy, intravenous fluids and antibiotics. \u00a0 However, there are other options like intensive care or major surgery that may only add to his\u00a0<b>suffering<\/b>\u00a0without significantly improving his chances.<\/p>\n<p>It is possible that despite anything we do, he will continue to\u00a0<b>deteriorate<\/b>\u00a0to a point where either his breathing or circulation will abruptly fail.\u00a0 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.<\/p>\n<p>I know that the possibilities I have outlined are quite\u00a0<b>confronting<\/b>.\u00a0 He and you may not have had the opportunity to talk about them before.\u00a0\u00a0 I also appreciate that you may not have\u00a0<b>expected<\/b>\u00a0that it would come to this.\u00a0 Many of us\u00a0<b>hope<\/b>\u00a0that our loved ones slip away peacefully and quickly but unfortunately some of us aren\u2019t given this opportunity.\u00a0 However, I think it is important to discuss this now in view of your father\u2019s illness.<\/p>\n<p>The most important thing is that all of us\u00a0<b>respect<\/b>\u00a0his wishes, his comfort and his\u00a0<b>dignity<\/b>.\u00a0 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.\u00a0 In regard to this, I need you to consider his current\u00a0<b>quality<\/b>\u00a0of life and how he would have liked to spend his last few weeks or months.<\/p>\n<p>Can I leave you now for a moment now to have this conversation with those closest to him and think it through? \u00a0 I know this feels like a heavy\u00a0<b>responsibility<\/b>\u00a0but it is also a\u00a0<b>privileged<\/b>one.\u00a0 I also believe you are the best person to make it because you have known him the longest.\u00a0 The main thing you all need to try and do is to\u00a0<b>step into his shoes<\/b>\u00a0and consider what he would have wanted. How would he have wanted his last moments to be\u00a0<b>remembered<\/b>, rather than what everyone else would have wanted for him or from him.<\/p>\n<p>I will speak to you again shortly to answer any further\u00a0<b>questions<\/b>\u00a0that will help you make this decision. Remember that regardless of the\u00a0<b>outcome<\/b>; I want to reassure you that we will try to make his\u00a0<b>comfort<\/b>\u00a0a priority regardless of the situation and that you will be kept regularly\u00a0<b>informed<\/b>\u00a0about our plans.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>TweetHere is an example of how to begin the discussion I would like to speak to you in private about some\u00a0important\u00a0things concerning your father. \u00a0 Based on our most recent&#8230; <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/09\/24\/end-of-life-discussions\/\">Read more &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":1007,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"episode_type":"","audio_file":"","cover_image":"","cover_image_id":"","duration":"","filesize":"","date_recorded":"","explicit":"","block":"","filesize_raw":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-1006","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/1006","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/comments?post=1006"}],"version-history":[{"count":1,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/1006\/revisions"}],"predecessor-version":[{"id":1008,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/1006\/revisions\/1008"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/media\/1007"}],"wp:attachment":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/media?parent=1006"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/categories?post=1006"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/tags?post=1006"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}