Remove some of the barriers to end-of-life planning

Before we can have better end-of-life planning, we should first remove the barriers (Report urges better end-of-life planning, July 13).

Families are usually informed about the patient's deteriorating medical condition each time he is admitted, but families may not understand that the repeated admissions are a sign of imminent death.

This is because in times of stress, families cannot think straight. There are also doctors and nurses who believe their basic training does not prepare them to deal with terminal illnesses.

Moreover, there are just too few palliative care specialists.

These factors are barriers to good end-of-life planning.

Doctors and nurses must, despite stigma, superstition and discomfort, have the skills to talk to patients about death and dying.

Family members may also not know what level of care the patient would prefer, and end up allowing more medical interventions than the patient or even they would want.

Disputes within a family over end-of-life care may end up leaving provision of care at the default "all necessary care" setting, which could lead to interventions such as ventilators or feeding tubes, when these would be medically futile.

Some families may find removing life support to be more difficult than declining it, especially when the patient did not sign an advance medical directive.

Because death is such a personal experience and each individual's fears and ideals about it are so specific, it would be impossible to create a one-size-fits-all answer to how care should be provided.

Having an advance medical directive has benefits, but it may be misunderstood and its usefulness is limited in scope. Some people fear that an advance directive interferes with adequate care. In one sense, the directive cannot contemplate every possibility.

Appointing a healthcare proxy, an agent who makes healthcare decisions on the patient's behalf, is efficient but the patient may not receive the care he wants.

A better approach to planning for the end of life is needed. Talking about death or dying can bring up many uncomfortable thoughts and feelings, so wanting to avoid it is a common reaction.

But talking about death, especially with someone who has a terminal illness, can be helpful at any stage in the illness.

Cheng Choon Fei

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A version of this article appeared in the print edition of The Straits Times on July 16, 2019, with the headline Remove some of the barriers to end-of-life planning. Subscribe