Health and Psychology

Health Psychologists, Neuropsychologists, Neurologists, and Oncologists are the fields that have rather routine discussions about how patients want to live and be treated as they approach the end of their lives.  There is some basic information that needs to be covered either with the patient or with their family.

• Advanced Directives
• Active Treatment or Palliative Care
  
• Decision making if the patient is incompacitated-Durable Power of Attorney for Health Care
  
• Wills and Final Arrangements
• Religious Beliefs impacting treatment
• Amount of information about treatment decisions and risk/benefit analyses desired

No one lives forever.  Although that's a basic fact, few physicians or psychologists actually have training in conducting end of life discussions with their patients.  Some get supervision for those discussions in residency or fellowships, but many of them don't.  The conversations can get awkward.  When my mother was diagnosed with congestive heart failure, cardiac ischemia, and was not a surgical candidate, I was surprised her physicians were not talking with her about any of the information she needed.

I was fortunate in that the topic was covered in my health and medical psychology class and covered well in supervision and post-doctoral training.  So the conversation was an easy one for me.  It was also easy for my mother who absolutely knew "something serious" was wrong.  So she and I talked.  It started with the "what do you want to do with the year or so you have left?" question.

Her answer surprised me.  "I want to travel.  I want to do things with my religion.  I want to help people. I want to stop taking most of this damn medication."  So she decided to go to Hunan, China sponsored by her religious group, learn some Mandarin and Xiang, and teach English at a university there.  We covered what she wanted to do with her possessions in the United States and how she wanted them distributed.  That was done prior to her leaving.  She was clear that she may die in China and decided she would be buried there if that were to happen.  She made arrangements to return to the US in a year. we said goodbye at Los Angeles international Airport with both of us knowing she might not return.

For the 10 months she spent in Hunan we communicated by email.  She was having a great time.  She loved her students.  "It's the best thing I've ever done in my life."  She died of a heart attack in the company of her students on a walk back from a restaurant they went to for dinner.  I was notified by the American Consulate and the school where she taught.  Everything was easy for me and her family.  Everything had already been decided and discussed.  I notified all the surviving family.  Her religious group handled the burial arrangements in Hunan.  The school and her students were surprised by her death because she had not had the discussion with anyone there.  She was worried she would not be allowed to teach if they knew.  Had she been able to have the discussion it would have been easier on everyone like it was for her family here. 

Regardless of anyone's health, it's important to make decisions about how people want to manage things at the end of their lives and to communicate those decisions to everyone that's likely to be involved.  It makes the process much smoother.