Peaceful farewell

March 24, 2009|By Catherine J. Boyne and W. Anthony Riley

When Peggy Murphy succumbed to her five-year battle against breast cancer this month after a fight that included just about every treatment she or her doctors could find (including an experimental vaccine at the Johns Hopkins Hospital), those who eulogized her in print called her a "pioneer" and a patient with the unwavering "courage and strength" to endure almost anything in her struggle to live.

Nearly lost in the story of her death, as reported, was one sad detail - that the final month of the Lancaster County, Pa., woman's life was spent in an intensive care unit in New York, in the most clinical setting modern medicine has to offer. Ms. Murphy, ever the warrior patient, lived on a sterile unit, most likely hooked up to myriad machines, her family and friends' visits restricted by the confines of ICU protocol. Yes, her struggle against breast cancer and her desire to help those looking for a cure were noble and inspiring. But we have to wonder about that last month of her life. We hope that her decision to keep fighting came after an honest and thorough discussion of her end-of-life options. We hope that Ms. Murphy knew there were alternatives that could provide a less invasive, more family-centered end to her life. And we hope someone told her that choosing to seek a more peaceful death could, in fact, help extend her life.

Unfortunately, many patients with terminal illnesses are never told that there are benefits to forgoing "curative" treatments that are inevitably futile. Others learn that they have options far too late to take full advantage of the peace they can provide.

A study published in the Journal of Pain and Symptom Management in March 2007 found that patients suffering from six different terminal illnesses lived an average of 29 days longer when enrolled in hospice programs than their counterparts who did not. Why? For one, patients who are already weak from illness may be made sicker by some of the treatments used against their diseases. But perhaps more important, patients who are given the freedom to say goodbye are less stressed. They are able to cherish the time they have left with loved ones instead of focusing on the latest treatment.

Consider the path of another cancer patient. Given just a short time to live, a 46-year-old woman with end-stage breast cancer was taken from a hospital emergency room not to an ICU but to our inpatient hospice center. Her symptoms were brought under control, and she lived two more weeks, enough time to tie up the most important loose end of all: the decision about who would care for her two teenage daughters once she died. Her last weeks were spent in a homelike setting in a large, warmly decorated room with its own veranda and with her girls sleeping nearby.

Emotions often get in the way of a meaningful discussion of end-of-life issues, but it's important to remember that patients have choices - about medical care, about the place and manner of their deaths, about hospital care vs. hospice. All of those choices need to be discussed openly and honestly, and patients need to be given permission to let go of the warrior mentality in favor of a more comforting end. Unfortunately, doctors often avoid these uncomfortable discussions in favor of one more treatment, and patients are not able to come to terms with their impending death.

In our society, the heroic struggle against insurmountable odds is a revered concept. But such a fight at the end of life can come at the expense of the peace a patient may need most as death approaches.

Catherine J. Boyne ( cboyne@gilchristhospice.org) is president and Dr. W. Anthony Riley ( wriley@gilchristhospice.org) is medical director of Gilchrist Hospice Care in Hunt Valley. Ms. Boyne also serves as the chairwoman of the Maryland State Advisory Council on Quality Care at the End of Life.

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