Make End-of-Life Conversations Routine with Your Patients

Anu Suri, MD, staff in the Respiratory Institute, answers three questions about the moral responsibility of physicians to talk with patients about end-of-life care.

You are the facilitator for our Advance Directives subcommittees. What do you wish caregivers understood about Advance Directives and end-of-life care?

Dr. Suri: These documents are crucial as they communicate to us our patients’ preferences for undergoing life-sustaining therapies, and their chosen healthcare agent. This information is vital if they lose their medical decision-making capacity.

I hope that caregivers consider having conversations about Advance Directives and end-of-life care as a routine. Timely conversation is the key. The optimal time for such conversation is when our patients aren’t too sick to have such discussions and are able to express their wishes.

I hope that as caregivers we avail ourselves of every opportunity to educate our patients about their right to a dignified life and the end of it. Our patients look for guidance, and it is our moral responsibility to give them an honest opinion so that they are appropriately equipped with relevant knowledge and can make informed choices for end-of-life care.

How can we do better at respecting patients’ end-of-life wishes?

Dr. Suri: Starting a conversation is the first step. It is imperative to accept that death is as natural of a phenomenon as birth.

Changing the culture about end of life or being comfortable having such conversations isn’t an easy task. We are trained to save lives, however there may come a time when our interventions are not only medically futile, but may also have a negative impact on our patients. Accepting such limitations and having an honest conversation with our patients and their families is something I view as a major opportunity.

How you build meaningful relationships with your patients?

Dr. Suri: Be there for the patient as a caregiver, not just their physician. There is a difference.

I feel that being a good listener, and spending adequate time with patients, is critical to establish that bond. I focus on that every time I am with a patient. This helps me immensely in making a connection with them.

Being empathetic and caring also helps earn the patient’s trust. Once you have trust, it makes it easier to navigate through some of the challenges we face.