How Would You Die as a Terminally-ill Patient?

Life is full of limitless opportunities. Yet, there is also a roughly-edged limit to life — and that limit is caused by time and perspective. This is especially true in the stories of terminally-ill patients.  In “Letting Go” by Atul Gawande, a woman named Sara was diagnosed with lung cancer during her pregnancy with her first child. As a non-smoker, healthy and exercising individual, the news was shocking. From that point on, Sara and her family began the spiraling route towards an “aggressive managing” of the cancer. Despite their efforts and open-mindedness to a multitude of treatments and drugs, cancer was beating Sara. There was simply no cure. At this point, if you were Sara, how would you like to live out the rest of your life? Would life-prolonging drugs be the way to go? Or would you use drugs to diminish your pains and, thus, heighten the quality of your end-of-life health?

As a terminally-ill patient, there seems to be only two options: It is either to fight or to let go. Both options include a certain degree of acceptance of death. With the first option, the patient would continue to fight with the slim chance of overcoming death. During this  fight, the patient would continue to use life-prolonging drugs and other treatments in an attempt to cure the disease. The other option is to let go and let the natural course of the disease to pass through. Awhile doing so, the patient could use medicine to guide themselves to a peaceful death. There is not one right option; however, whatever the patient decides is the best option for them. If you knew you would die anyway, what would you choose to do? Try to think of the long-term effects of your decision before you commit to it.

Some things to think about:

  • Is it cowardly for others to accept their fate and not fight with life-prolonging drugs?
  • Or is it more cowardly for others to fight against the disease knowing they would die anyways (because they refused to accept death)?
  • If you were going to leave your family with expenses, because of your death process, what would you do now to aid them with that?

With that being said, medicine should do whatever the patient desires. Even when the treatment cannot save his/her life, the patient should have the last word on what type of treatment they would like to go through. With me, personally, if I was facing a terminal illness, knowing that my family would be left with prolonged grieving and financial expenses on behalf of me— I think I would just let go. I would like to consider my decision as rational and practical for my interests and my family’s interests. For end-of-life medicinal measures, I would use anything to lessen pain or calm my anxieties. However, if I wasn’t suffering greatly, then I would choose to not use any medication. That way, I would leave quicker and I would not drain extra expenses. That would grant me the most satisfaction for that situation.

End-of-life care doesn’t need to be scary or bleak. Although there is always a limit, there are always choices that you can make to improve the life of your own and the life of others around you.

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12 thoughts on “How Would You Die as a Terminally-ill Patient?

  1. It must be a very hard decision to make the choice on trying to prolong your life or just accept whatever is coming. Some of the questions presented at the beginning of your blog really had me visualize myself in Sara’s position. If I had just gave birth to my first child and was about to start my new life with my new family I would do anything to stay with them as long possible, even if that included taking medicine to prolong my life. Knowing that if I didn’t take any medication I would die possibly sooner, anything would seem promising and the longer I have to be with my family the better. Sara was a mother and her choice to test out any drug that could potentially save her reassured her enough to carry on treatment and not give up. Sara made a very noble decision that, I would imagine, any mother would’ve made. From my own point of view, I agree with you on your decision to just “let go”. Like you said there are always choices we can make to better ourselves as well as others, for Sara it was prolonging death in order to live and be a part of her child’s life. For me I would choose to end treatment and since I don’t have a child I would do what I could to embrace and enjoy my death with friends, family, or myself!

  2. I agree with Juan, it’s an extremely hard decision to make the choice. No matter what everyone’s decision is going to be different, because of different matters. Just like Juan also stated how she was a new mother of her first child, and just like most mothers she chose to fight. Sara was an extremely brave woman and I think it also helped because she had a lot of support. I like how you asked the question “Is it cowardly for others to accept their fate and not fight with life-prolonging drugs?” It’s like a double sided coin, yeah some people may believe that they are acting cowardly for saying no to life-prolonging drugs, but others might believe that’s it also cowardly for nature not to just take its course. This story was very difficult for me to grasp because I honestly don’t know what I’d do until I was put into that situation! I feel like many patients are stuck when it comes to this decision because of loved ones. For example, someone could have cancer and want to let go but their children still want them a live and want them to fight. Medicine should do what the patient desires, no matter the choice. The patient should always be comfortable, although sometimes hard.

  3. I like that you incorporated the idea of using medicine to calm anxieties at the end of life. It seems like we generally tend to focus on the pain on death and not the emotions that the dying person is experiencing. I also thought that you mentioned some great points to think about. The point about financially preparing your family for your death sooner rather than later is something we should all think about now while we are young. Many of us seem to think that we are invincible and that tragedy won’t strike us while we are young. Hopefully it won’t, but it would still be beneficial to prepare for tragedy just in case.

  4. I agree with your decision to allow yourself to die if the sickness is winning, but I personally don’t think it is that simple. Honestly if I was sick and I told my family that I wanted to die I don’t think they would mince words with me. Even if it was the logical and beneficial thing to do I believe it would be very hard for them to let me go without a fight. I don’t think I would be able to hold up under continuous pressure from my family if they were crying and telling me to keep trying different medicines to keep me alive. I would know that it is the right decision but I would cave very quickly.

  5. It’s true, there is no right or wrong decision when it comes to the choice of fighting or accepting death. There is only a best choice for each and every individual, and they should be the one who has the power to make it. It is always good to ask yourself questions like the three you did, in order to figure out what is motivating you towards one choice or the other. But ultimately, we must choose what we truly want, because we don’t take anything or anyone with us when we die. It’s just us. Whichever option brings you peace in your heart is the way to go.

  6. I like the questions that you presented. Especially the first two. I didn’t think much about death before this class except for when I did a project in my religions class about how different religions view and handle death. After learning all that we have so far my opinions have changed a lot. It’s very brave for someone to let go and know when it’s time to come to terms with dying. So many people die without peace because they never learned how to come to terms with their mortality. I now believe that if I were struck with a life threatening illness I would rather start coping than continue fighting after all possible treatments fail. At this point, I don’t think I would take drugs just to give me a few more months to live. It’s just delaying the inevitable and will make it harder when the time has come. I would much rather do palliative care until it’s time for hospice and live the rest of my life out to the fullest with the people that I love. I wouldn’t say that any of the ways people handle the end of their life is cowardly though. Everyone has a motive for why they do things and how they react to certain situations. My wish though is for some sort of program to be implemented across the board for everyone to get help when their end time is near. The thought that so many people die in distress is saddening.

  7. Originally I was seeing the story of Sara by faulting her doctor: I held Sara’s doctor responsible for not directing Sara and her family towards a more relaxed form of treatment, I blamed her doctor for overestimating her chances and encouraging her to go through the intensive treatments her family and her were seeking.
    Reading your post, you raised an amazing point that most doctors tend to do what patients want them to do, regardless of pain or side-effects because most patients tend to enter that phase where they would like to battle their diseases head-on.
    You raised other very important questions that are subjective, vary from person to person, and are very debatable: are you a coward if you decide to let go and accept your fate, or are you a coward if you decide to fight against the inevitability?
    Today, I want to say that if I were ever facing a life-threatening illness, I would accept my fate, spend more time with my family, seek ways to increase the ‘quality’ of my life before I departed from this world. In reality, I wouldn’t know what decision I’d actually make till I really found myself in a situation like this.

  8. I think that you raised several interesting questions in your post and also brought the topic home and encouraged us to relate to Sara and put ourselves in her situation. As you said, there isn’t a right option when making the choice to let go or continue fighting so I don’t think one is more courageous than the other. If you stop seeking treatment, you are brave in your acceptance and willingness to face the unknown. If you continue treatment in spite of the odds, your courage shows in your resolve and ability to continue despite pain and suffering.

  9. I completely agree with you. I believe that medicine is supposed to be what ever the patient wants it to be. Whether it be a pain reliever or a life savor, medicine should do what the patient wishes for it to do. I know I would probably do what you would do, and use medicine as a pain reliever and and accept my fate. I most likely would try and fight it first though, and then if that doesn’t work I would refuse all life saving treatments. I would want to live my last days of quality, and not spending them trying to save something that’s already gone. I think that a persons last days should be filled with joy and should try and look back at the good things that happened to them, and not dwell on an illness that they couldn’t do anything about. However, I also respect those who have that ‘never give up’ spirit and want to fight for their lives until the end because that takes guts. Never losing hope and seeing the good in today and tomorrow.

  10. I have to agree with you. Medicine should do what the patient wants it to do and not what the doctors want. Even if the medicine isn’t going to cure them, if anything it will bring the patient comfort and ease the pain that the illness would eventually give to them. I also believe that it should be the patients decision on whether to stop the treatment or prolong it. Medicine shouldn’t just be up to the doctors and what they want. Especially after so many tries and different medicines used. If the patient wants to continue trying, I think the doctors should do what the patient asks them to do. Money and time shouldn’t matter. A patient who has an illness all they live for is time and if that’s what they can give to them then so be it. I really liked your post and how you organized all your thoughts. It really got me thinking about my own experiences of death and how my dad fought to hang onto life. He ended up losing his battle to cancer, but I do understand what it’s like to fight for time.

  11. Although I might say that I would not excessively use medicine in order to prolong my life if I was terminally ill because I do not want my family to be left with unsurmountable expenses, I think when I am actually in that situation, my choices and decisions will be very different. When we are actually faced with death, our emotions are all over the place, and for some people they just want all the craziness to end. For others, material things like money and other people’s opinion do not matter, the only thing on their mind is survival. They will do anything to live. I think I will be one of those people. I have to be in control of every situation. Simple things such as going on roller coasters or flying on a plane terribly frighten me. So to think of letting go of my life is almost impossible to comprehend. Even though, I was at an old age, and with a terminal illness, I think I would be attached to every machine possible in order to keep me alive.

  12. I completely agree with the fact that there really are only two options, and like you said, they are fight or let go. However, I don’t agree that both include the acceptance of death. I feel that the ‘fighting’ part is more of a declining of death. I think for those that have the strong will to fight are those that do not want to die. They want to do everything in their power to keep their lives the way they currently are. I view that more like they don’t see death as something imminent but they feel that with today’s medicine their death isn’t something that is going to happen. I do not think it is cowardly for those to refuse treatment because of either cost or the drugs involved. Many people out there with life ending conditions understand what’s going to happen and don’t want to leave the burden of thousands upon thousands of dollars of bills leftover after they die just to extend their lives by a few months. I actually feel that’s more mature than it is cowardly.

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