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Mental Health Center

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Are Americans Afraid to Talk About Dying?

Talking to Family, Friends Helps Make End-of-Life Decisions


"We don't just have these answers written on our shirtsleeves so we can read them off," Lynn says. "We need to think about these issues over and over. These are not things you do once and they are all taken care of. As life circumstances change, they need to be rediscussed."

When deciding about your end-of-life care, Goldstein says, only one thing really matters: Living the end of your life according to your own goals and values.

"The important thing to remember is that what matters is not what the doctor or the family would want, but what the patient would want," he says. "Our job as doctors is not to elicit what the family would want but has the goal of learning what the patient would want."

We don't have to understand every kind of medical procedure. We do have to come to terms with what is most important for us.

"We do not ask patients whether they want this or that treatment," Goldstein says. "We ask, 'What is important to you in terms of your health care? What are your goals in life?' So when we do that, we can say, 'Well, in terms of what you said, these are the treatments that are appropriate. These treatments are what meet your goals.'"

There are two different legal documents that improve our odds of getting the end-of-life care we want. One is a living will. A living will spells out what kinds of extraordinary medical treatments we'd like used to keep us alive, in the event we become terminally ill or permanently unconscious.

While living wills are legal documents, you don't need a lawyer to get one. They are available free on the Internet. After explaining your wishes, you just need two witnesses to sign it.

"A living will gives patients an opportunity to express in their own words what is important to them," Goldstein says. "The difficulty is they often start with phrases that can be interpreted differently by different people. Like, 'If I am permanently unconscious or brain dead.' That is a clear statement in a narrow context. It tells us what a person would want but only in very defined conditions that may not come to pass."

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