Wit-DNR scene and Steel Magnolias

 

Wit:

https://youtu.be/RS8Bqgie_RA

 

Steel Magnolias:

https://youtu.be/hn09SKCZgtI

https://youtu.be/03BPiyoab10

 

Guiding discussion:

 

“Is death a friend or an enemy, to be acquiesced to or to be fought? American medicine is simply not sure about the answer to that question.”

Frustrated mastery—The cultural context of death in America. West J Med 1995; 163:226-230.

 

• What do you find most difficult about having end of life discussions?
• Are their specific instances when the discussion went particularly well. Can you describe the context? What about discussions that didn’t go as well?
• How do respond to questions of uncertainty? Whether it’s an unknown prognosis? An uncertain future?
• Do you feel comfortable acknowledging uncertainty in such decisions.
• How do you work through conversations with patients and families that are clouded with uncertainty? Do you find yourself focusing on questions that have answers? Did you find uncertainty too difficult to deal with given the pressures of emergency medicine practice and steer away from such issues? Do you feel comfortable framing discussions with patients and families that relate to questions and concerns for which there are no answers.

 

Exercise:

Complete your own advanced directive (MOLST form here). Discuss with your family and friends your wishes. What kind of emotions did it bring? Did your family want to have this discussion? Studies show that many seniors say their children don’t want to talk about end of life issues. Their children, in turn, say their parents don’t want to talk about death. Did you find challenging the idea of predicting the future? What you would want done for some unknown disease with unknown treatments? How did you frame the discussion? As discrete scenarios, or as values? What makes life meaningful for you? What life events give you the most joy? Ethical, religious, spiritual beliefs? What do you value most about your physical and mental well being? Fears about end of life? Acceptable burdens and minimal acceptable quality of life? Under what conditions would life become unbearable? If you could plan the last day of your life, what would it look like? Who do you feel would most object, if any, to your end of life wishes?

(adapted, in part, from Caring Conversations Workbook, Center for Practical Ethics, Kansas City, MO)

 

 

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