When broaching the subject of honoring your patient’s final wishes regarding end-of-life care, choose your words carefully. Words are powerful things! They have the power to leave lasting wounds, without leaving any external sign of trauma. When families hear the words “withdrawal of care,” they often associate it directly with taking something “away” from their loved one, rather than actually honoring their loved one’s final wishes. In that moment, they’re already having their loved one “taken away” by disease, illness, or trauma for which they may have had little time to prepare. They often feel as if they’ve lost control and are helpless. They may feel that if they elect hospice, palliative care, or comfort care that they’re in essence “giving up” on their loved one. Consider telling the family about giving their loved one the final “gift.” The “gift” is a way of communicating an option that conveys the family’s control over a situation they likely is beyond their control.
In situations such as this, I’ve told many family members that the last gift they can give their loved one is “letting them go” in peace, surrounded by family and friends. This gift comes from the heart, from the memories the family recounts and in honor of what they know their loved one wants. It’s the kindest, most unselfish, and also the most gut-wrenchingly difficult gift they’ll ever give anyone. For some families, they’ll never reach a point where they can give this final gift to their loved one. And that’s 100% okay. Reinforce to the family that the nursing team will be there to support them no matter what their decision.
I’ve found that when emotions run high, if the family is given ample time to reflect on what I’ve said, they’re more inclined to adhere to the patient’s wishes. The gift of letting the patient go and honoring his or her last wishes regarding end-of-life care can bring emotional closure to families. I’ve found that by carefully proposing the option of the “gift,” rather than “withdrawal of care,” the emotional turmoil of all involved may be eased. No matter what the family’s decision, our job is to provide support to the patient and family during this difficult process.
By Charlotte Davis, BSN, RN, CCRN
CCU/CVICU Direct Care Nurse • Heritage Medical Center • Shelbyville, Tenn.
Direct Care Nurse/Charge Nurse • Alvin C. York VA Medical Center • Murfreesboro, Tenn.