Kenneth L Abbott, MD, FACP  |  1/3/2022

Making Your Life Care Wishes Known

How can you think about and make important decisions about the kind of cancer care you want? What about other, often equally important, matters?

This is where having that good and reliable information I have mentioned before comes into play, where the investment of time and effort to have open and honest communication with your physicians, nurses, and midlevel providers pays great dividends. Well-informed thinking facilitates good decisions.

By letting your care providers know what you want done in certain circumstances you make their caring for you easier. This should happen at all points of your cancer care, too, and not just about the big, end-of-life questions. What are your goals for cancer treatment? Do you want the maximum for the best possible outcomes? What are you willing to put up with in order to get there? Maybe your goals are more modest. Would you be content with less rigorous therapy, possibly trading length of life for a better quality of life during your remaining time? Beyond the specific matters of health care, you should consider the implications for all of life. Do you have a certain life goal, maybe a bucket list item or a family event, toward which you strive? Perhaps the knowledge of a limited prognosis will spur you to take an action best accomplished now rather than put off until possibly too late. That video recording to be played at your young daughter’s future wedding, or a memoir you’ve intended to write as a legacy for your son, or that family trip you’ve always wanted to take—there may be no better time than the present to make these wishes and plans real.

Most people know about advance directives, legal declarations we can make of our wishes to guide others in medical decision-making in the event we cannot speak for ourselves (a serious stroke or a coma, for instance). And many know of the right to designate another trusted person to make treatment and support decisions for us through a durable power of attorney for health care. In Maryland, we also have the Medical Orders for Life-Sustaining Treatment (MOLST) form that will take someone stepwise through various important kinds of medical care, from the use of CPR and ventilator support though matters a person may not think about at first, such as antibiotics, blood transfusion, and dialysis. Blank forms are available in many provider offices or on the internet. You don’t have to be terminally ill in order to fill out a MOLST form and provide copies to everyone who should have one. In fact, the best time to consider and complete a list of personal wishes for life-sustaining treatment is before you have threats to your life.

Talking about such matters with close family members can be uncomfortable at first, but just about everyone who does so is glad and at greater peace once the conversation takes place. Having the important questions settled well in advance relieves many burdens.
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