Earlier this week, my colleague pointed to a New York Times essay penned by VJ Periyakoil, MD. In it, Periyakoil calls for a role-reversal in talking about end-of-life issues and encourages patients to take the lead in starting such conversations with their doctors. "Without these conversations, doctors don’t know what the patients’ goals are for living their last days," she writes. "What are their hopes, wants, needs and fears? Do they want to die at the hospital connected to a machine? Do they want to die at home? The current default is for doctors to give patients every possible treatment for their condition, regardless of its impact on the patient’s quality of life, the cost or the patient’s goals."
Periyakoil goes on to describe a letter that she and her colleagues created to help facilitate these patient-doctor conversations. The video above expands upon the Stanford Letter Project, which helps patients map out what matters most to them at the end of life, and includes the candid thoughts of numerous older adults.
"If I'm brain-dead, unplug me," one woman says matter-of-factly. "And I want to die painless. No pain - just put me to sleep and don't let me wake up."
In the doctor's office, one man shares his reason for writing a letter and expressing his wishes: "One of the worst things in the world that you can have happen [is you're on] your deathbed and you're putting the burden of life-altering decisions on a family member that has no clue of what you really want or don't want."
Advises another older man: "Don't be ashamed of it - everybody dies. Just discuss it and agree on what you want."
Previously: How would you like to die? Tell your doctor in a letter, In honor of National Healthcare Decisions Day: A reminder for patients to address end-of-life issues, Study: Doctors would choose less aggressive end-of-life care for themselves, On a mission to transform end-of-life care and The importance of patient/doctor end-of-life discussions