to the editor: The article on end-of-life care provided a number of useful practice suggestions for communicating effectively and compassionately with patients and their families who are dealing with the difficult issues that accompany terminal illness. The authors appropriately identified the frequently asked question, “Do you want us to do everything that we can to keep you alive (e.g., artificial life support)?”, as one which often leads patients and families to conclude that choosing anything other than all available care means not obtaining the best available care. Framing questions in this fashion, without providing appropriate medical context, leaves patients and families at a tremendous disadvantage to discern what alternatives and approaches might be available to them to obtain the most effective end-of-life care.
An alternative approach would be to initiate this type of conversation by posting a positive framework: “In the event you become extremely ill, I would suggest we use treatments that offer a real chance at meaningful recovery, and not embark on treatments that do not offer a real opportunity to provide you a meaningful benefit. Would you like to talk about the types of therapies that might fall into each category?” This approach has been effective in helping patients and their families cope with the difficult situation of terminal illness care in a way that is collaborative and appropriately shares decision-making among patient, family, and physician.