Dr Pamela Prince Pyle

Making End of Life Decisions for Loved Ones

Sharon was dying. The weight of this reality hung in the air. Cancer had come and gone and returned with a vengeance.

Through it all she had carefully considered each treatment decision and weighed the various therapeutic options.

Nevertheless, an unexpected complication resulted in a devastating consequence. Her family stood by, hoping for her to wake up. They yearned for more time to hear her voice and her wishes. They had expected more time to make these decisions, and they were now ill-equipped without her wisdom.

A Common Story: Making End of Life Decisions for Family Members

I spoke daily with Sharon’s family, as did the other physician involved in her care. We understood the difficulty the family now faced. We had been in many family consultations such as those we were having with Sharon’s family. A serious diagnosis or tragic accident rendered the patients unable to speak their wishes, and their families struggled with chaotic decision-making.

In some cases, the answer was clear to everyone involved. In others, such as Sharon’s case, the family was in turmoil. She had completed an Advance Care Plan early in her cancer diagnosis. She had spoken with her family about this plan. However, everyone expected an ending they would see coming, not the one they were given.

Time and Trust

When families are faced with making decisions about withdrawal of care, there are three approaches I use to help guide them. Families can utilize this decision tree for their individual circumstances.

  • Work the Plan: Even if the patient left only a rudimentary end-of-life plan, it can become a starting point for care decisions when the patient is unable to participate in choices. In Sharon’s case, she had chosen not to have any life-saving medical interventions. Each family member understood this, and yet now in the chaos they wanted it all done. From the family’s perspective, they hoped for more time. Reality had not yet set in.
  • Develop trust: Trust is the most valued commodity between clinicians and patients. Developing trust in a medical crisis still requires time, patience, and often more than    one physician offering their perspective. You will be surprised by the trust-bond created by the simple question, “What would you do if this were your spouse?” If he or she is not married, ask who they would want to make this decision for them.                                                                                                                                                           
  • Consider the Patient: If the patient has not completed an Advance Care Plan or communicated clearly his or her wishes for end-of-life, gather the people who know the patient the best. Consider the following questions:
  1. How did the patient value quality of life vs. quantity of life?
  2. Did the patient discuss being prepared or getting ready to go?
  3. Did the patient begin giving items away or planning for a will or funeral?
  4. Identify the patient’s belief or faith. Be prepared to answer questions surrounding faith.

Despite this approach to making end of life decisions for loved ones, the weight of a final decision to withdraw artificial life support or to transition to Comfort Measures Only can feel heavy. 

Sharon’s family had been told that she would not have meaningful recovery. She had planned for an ending on her terms, but this was no longer an option. Another physician and I sat together in the crowded consultation room. We both agreed that withdrawal of high acuity care was indicated and explained the reasons. However, families understandably struggle when decisions like these must be made. 

The Most Important Thing You Should Know About End-of-life Medical Decisions for Family and Friends

Early in my career I also struggled with these conversations. I could present the science and statistics, but that does not begin to explain the nuances of patients’ lives at the end-of-life. Some last longer than expected, while others with the same data set die quickly. It is a road fraught with the unexpected, and absolutes can give false hope or false despair. I began to find comfort in Scripture and God’s sovereign Word, and this has allowed me to share comfort regardless of the faith experience of patients and their families.

“Your eyes saw my unformed body;

all the days ordained for me were written in your book   

before one of them came to be.”

Psalm 139:16

“A person’s days are determined; you have decreed the number

of his months and have set limits he cannot exceed.”

Job 14:5

“Is there not an appointed time to man upon earth?

Are not his days also like the days of a hireling?”

Job 7:1

“If a man die, shall he live again? All the days of my appointed

 time will I wait, till my change come.”

 Job 14:14

Preparing for Death by Living with the End in Mind

My faith gives me confidence that the number of our days is ordained by God. When I speak with patients, families and healthcare proxies regarding end-of-life care options, I add the following, “My faith comforts me with the belief that while we can’t control how many days of life we get, we can always choose how we will live those days.” I find this simple statement brings a visible sigh of relief as families are making decisions regarding level of care.

As a person of faith, I believe we are the beloved creation of an intelligent, all-powerful Designer. I see no contradiction between the principles and facts of science and the idea that an all-knowing Creator would know the exact number of my days.

I prefer to think of our lives as books. Our daily choices and actions determine what gets written on the pages of our lives, but the Author of life determines how many pages are in each of our “books.” In short, my faith gives me both peace and a confidence to comfort patients and family members as they walk through their final season.

This is not to affirm the choices of suicide or euthanasia. While the date of either is the patient’s day of death foreknown by God, the psychological consequences for those left behind can be tragic and unresolved. Choosing withdrawal of care resulting in a natural death is entirely different than an active intervention meant to cause death. Society cannot fully understand the ramifications of euthanasia or the slippery slope to which it leads.

During these end-of-life decisions, patients and families need clinicians who will guide them. They don’t need someone to lead them (make decisions for them), and they don’t need someone to follow them (they make all the decisions). Regardless of their faith, they find comfort in my faith, that I believe they are not taking or adding a day to the life of the patient. They are deciding what that day will look like.

6 Responses

  1. Dr Pyle,

    We as Funeral Directors are sometimes in this position when a Preneed is being discussed. Not making treatment decisions, of course, but guiding the family towards the final disposition the dying would want. Sadly, it is with some that the final disposition is merely a sprint to try to bury the pain. Having Faith in God, guides us to help the families make the decision that is best for their loved one and family. I often feel blessed that God put us in this position to help families with final disposition of their loved one.

    1. Joseph,
      I am so thankful for your comment and your heart for God. We are in unique positions to share hope in the midst of suffering through faith. I would welcome you sharing my website to help people as they are making choices about end-of-life care.
      Interestingly, a funeral director led my dying uncle and my mother to Christ as they discussed his funeral plans.
      Thank you again,
      Dr. Pamela

  2. I do not even know how I ended up here but I thought this post was great I dont know who you are but definitely youre going to a famous blogger if you arent already Cheers

    1. Hi Jerry,
      Thank you so much for your kind words. God works in mysterious ways including having us end up on a blog that may add value to our lives. I don’t care so much about fame, but I do care about people. I’ve practiced medicine for over thirty years and I realized that I was limited by the amount of time that I had with each patient. My blog is meant to bring tools to patients and families for their physical, mind, and soul care. I also have free resources on my website https://www.drpamela.com. In January of 25 my book, Anticipating Heaven: Spiritual Comfort and Practical Wisdom for Life’s Final Chapters will launch. I desire to bring hope regardless of age, health status, or belief system. I would love to have you sign up for my blog Living with the End in Mind on my website, and spread the word if you find value in it. Thank you again Jerry and God with you!, Dr. Pamela

  3. I am uncertain of the source from which you obtain your information; however, the subject matter is commendable. I require further study or comprehension in this area. Your magnificent information was precisely what I was seeking for my mission.

Leave a Reply

Your email address will not be published. Required fields are marked *

Find Me Elsewhere

Follow Along

Don't miss out — sign up for Updates

Living With
The End In Mind

Thank you for being here!

Before you go, please consider signing up for my newsletter so that you never miss a post from me. I will periodically send you emails sharing what I have learned from my patients, a life in medicine, and from my faith in Jesus Christ. You will also get exclusive access to monthly Zoom meetings with me where I answer questions, pray, and bring hope to every season. No worries if you don’t Zoom, we will teach you or you can call in to listen.