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Incurable and Irreversible

Posted on 03/08/2013

ABIM Foundation: At a very stressful and emotional time, my wife and sister-in-law were left guessing what exactly those words meant and what their mother would want (because of my mother-in-law’s dementia, my sister-in-law has power of attorney). They asked me what I thought they meant. I hesitated and could only give them an answer based on what I would have wanted. Her daughters’ desire was to prevent pain and suffering, and see if her baseline functioning could be restored. A Do-Not-Resuscitate (DNR) was not ordered because it would mean withholding care that could save her life. I listened and tried to run through different scenarios with them: What it would be like if she had a heart attack, if she couldn’t eat, etc. It seemed like we were at a crossroads and  decisions needed to be made. Yet it was only after she was in a rehabilitation center that a DNR was put into place by her daughters with the guidance of a geriatric physician.

Ironically, the previous week I was on the phone with The Conversation Project’s Director Harvey Freishtat, and Project Director Lindsay Hunt. The Conversation Project was created by Ellen Goodman, the highly acclaimed op-ed writer for the Boston Globe who had a terrible experience caring for her mother at the end of her life. The project now operates in collaboration with the Institute of Healthcare Improvement and is dedicated to helping people talk about their wishes with their loved ones. Their Conversation Starter Kit asks the hard questions to enable conversations with family members.

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