What do you want the end of your life to look like? If you haven’t considered this, and talked about your wishes with your loved ones, you should. If you don’t, you risk ending up on the “end of life conveyor belt”. A situation that occurs when your family members can’t agree about what you would want when you can’t speak for yourself, they can’t let you go, and when physicians offer the next treatment modality (because that’s how they’re trained and it’s available), and don’t know how to say no.  Not a good thing, unless that’s what you want. Where all stops are pulled, every last ditch attempted. Even in a futile situation.

Dr. Jessica Zitter is an ICU physician with years of experience. She comes from a family of physicians trained to treat and cure. It took an ICU nurse colleague, Pat Murphy RN,  accusing her of “torturing” a patient to start her evolution. She began to understand that just because treatment modalities are available, it is not always in the best interests of the patient. That the need to prolong life at any cost is not necessarily a good thing, unless the patient has expressed these wishes. And if they haven’t, this leaves everyone else trying to do the right thing. Which can balloon into the wrong thing.

Dr. Zitter believes that this conversation needs to begin in high school. She is a proponent of Sex Ed and Death Ed. That the conversation starts in adolescence, and a person’s wishes can change over time. We both believe that the earlier these conversations occur, the more likely that a culture shift can occur and we can stop this “conveyor belt” for those that want to get off (or not get on in the first place).  She offers resources to help you sort this out.

Extremis is a documentary, currently on Netflix, which follows 2 families through the process of decision making for their loved ones who are intubated in the ICU. It is a raw account of the families and professional caregivers struggles to make the right decisions for the patient. It’s a very real picture of what goes on every day when conversations haven’t been had, and documented, as well as an excellent visual about the necessity of advanced care planning.

Dr. Zitter’s book, Extreme Measures: Finding a Better Path to the End of Life     offers stories of patient/family ICU experiences, as well as  valuable tools in the appendices for guidance to help you process this information and develop your own advanced care plan.

Other resources she mentions:

Vital Decisions, a  company whose mission is to be the force, the catalyst in this country, to fundamentally change how individuals are cared for during an advanced illness.

Serious Illness Care , a joint health system innovation center working to save lives and reduce suffering, started by Atul Gawande

The goal is that everyone gets the opportunity to live the way they want to live, all the way to the end. Our job as health care providers should be to help family members navigate the process, based on their loved ones wishes. Because with the advances of technology, there will always be that one next thing. The issue is, would you want us to go there for you…

You can find links to Dr. Zitter’s social media (and her book)  on her website jessicazitter.com

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