Medical Author: Benjamin C Wedro, MD,
Medical Editor: Melissa Conrad Stöppler, MD
According to news reports, Senator Ted Kennedy died from complications of a malignant brain tumor on August 25, 2009, at his home surrounded by family. A seizure that occurred more than a year ago, led his doctors to find a malignant glioma of the brain, a non curable cancer than often causes death within a couple of years. But while death was inevitable, treatment with radiation and chemotherapy allowed Senator Kennedy to continue his work in the Senate and enjoy family and friends.
In the last days and weeks of his life, presumable knowing his life was near its end, Kennedy tried to put his affairs in order. He asked the Massachusetts legislature to plan his successor in the Senate, and it seems that he had direction for his personal life as well. He passed away at home with dignity surrounded by family.
End of life decisions are difficult for a patient to consider because it means reflecting upon one's own mortality. It is difficult because family members and friends need to be informed about those decisions and be willing to communicate those wishes to health care practitioners.
Effective conversations about end of life optimally occur before the end of life is imminent. These are issues that each individual patient must formulate based upon their own beliefs, moral fiber, and personal experience. And the discussions can be helped by a guide, such as a health care provider who can fairly present "what if" situations so that informed decisions can be made. The decisions made aren't written in stone, because situations and beliefs change. Ultimately, any decision made about providing or withholding care happens at the time a medical action is necessary.
This is where it gets tricky. Not infrequently patients develop ideal plans when they ponder abstract philosophy, but change their mind in the heat of the battle when things get tough. A person, who is adamant that everything be done, decides that the pain and struggle of "everything" being done is inhumane and requests comfort measures only. Alternatively, a comfort or palliative approach can be rescinded if the patient decides more needs to be done.
If the patient can no longer make those decisions, they are too ill or unconscious, a power of attorney for health care can be designated to help the care professionals meet the needs of the patient, when the patient can no longer speak for themselves. That means that patients and families need to talk about topics that are uncomfortable, sad, and for some, morbid.
It seems that Senator Kennedy, in his passing, has demonstrated personal choice in his own terminal illness. Unable to predict the future and the "when" of his death caused by terminal brain cancer, he was able to choose "where" and "how"...at home and surrounded by family and friends. A dignified death that befitted a dignified life.
U.S. Department of Health and Human Services; "Advance Directives and Advance Care Planning: Report to Congress," August 2008.
MedicineNet.com; "Advance Medical Directives (Living Will, Power of Attorney, and Health Care Proxy)."
Gundersen Lutheran Medical Foundation, Inc.; "La Crosse Advanced Directive Study II; Does Advance Care Planning Make a Difference at the End of Life in La Crosse County?"