Counseling at the End of Life

As the debate on heath care reform heated up, the phrase “end of life counseling” was used as a canard by opponents of change. According to many of them, end of life counseling was the equivalent of a death panel where those worthy of saving would be, and those deemed too expensive to maintain would have the plug pulled. One would have to go back to the McCarthy period to find this level of accusation and inaccuracy. But where was it coming from?

There’s an Elephant in the Room:Issues in Death and Dying

Death is the ugly relative we don’t talk about. It’s hidden from our thoughts as if it doesn’t exist. Worse, we carry our perceptive blinders into our clinical practice. Entering a patient’s room, we tell them how good they’re looking, despite sunken cheeks and a sallow complexion. We may even make the mistake of asking how they feel. “Lousily,” they answer incredulously. “I’m dying you know!” We stare at them and mutter something later regretted, such as, “Oh, I’m sorry to hear that.”

Am I Dying? A Child’s Question

What would you say if a terminally-ill child asks the question? Should you be honest, probing, or try to convince her this is just a passing illness? The decision may be dictated by parental preferences or institutional policies. But what if there’s latitude in what you can say, or the moment is so pregnant with a child’s concern you don’t have time to consult with anyone? As with most things in hospice, there isn’t a right or wrong answer—just different ones.

A Bean Hollow Goodbye

A gray on gray Pacific coast morning begins as new yellow flowers push from beneath scarlet ice plant fingers, and a mother says goodbye to her son’s ashes.