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Preparing for End-of-Life Decisions


People need to openly discuss their end-of-life care beliefs and choices with their families and doctors, says Dr. James Tulsky, director of the Center for Palliative Care at Duke University Medical Center.

"There are two settings in which you may want to consider end-of-life decisions: in the context of serious illness, and as a healthy person looking ahead. In either case, one needs to consider what he or she personally values in life and communicate that to people you love through conversation and perhaps also in writing," Tulsky said in a prepared statement.

He said patients who are seriously ill and their family members need to ask questions of doctors and other health-care providers to get all the information needed to make appropriate decisions.

"It's important to ask your doctor 'what if' questions. For example, 'What if the surgery is unsuccessful? What is my option then?' People sometimes have difficulty discussing such issues because it is hard for them to consider that the treatment might not work. They may worry that a failure to remain positive could actually have an adverse effect on their outcome," Tulsky said.

He recommended that people hope for the best while planning for the worst.

"Patients should think through with their health-care provider what to do if a treatment doesn't go well and be willing to engage that. It doesn't mean that you are giving up; it just means you are considering all of your options so that you can make the best decision regardless of what you find," Tulsky said.

"Families should also ask physicians what they recommend. This is not, 'What would you do for your mother?' but rather, 'What should we do given what you understand about our mother.' Physicians should provide recommendations that reflect the patient's core values," he added.


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