Reading this I almost can see myself sometimes from both perspective : WHO will say it and SHOULD I say it? This topic is always so sensitive that it is almost hard to ever honestly open it up. I think that docs are those who should say it but they DO NOT. So, we are often left with the person who is suffering in the bed, with the family that suffers around the bed and us who suffer with them all, because feeling of failure that you can not save it from death or from sometimes prolonged suffering.
Gosh, it is always hard to even question how much do they really understand? When they need to see whole picture and do they see it or they are fed with a few sentences of docs saying " oh we started a new antibiotic and it works fabulous" Depends also where you work and what relationship you have with docs , what is his vision on death and dying...I know that some of them would put me on the wall if I mention DNR to the patient and patients need to know their options. So, question is who really should do it?Who is the one who opens that box ?
I usually question family about how they see situation , what is their expectation , what are wishes of their loved one to put it from their perspective and at the same time to try to open their eyes so they can question docs plan of care.
I give them our plan of care: "So, Mrs. N at this moment we are monitoring your husband, turning him and positioning q2 hr, looking his skin,a feeding tube, breathing through ventilator,and checking his vital signs as often as prescribed by doctors. We also take care that your loved one does not have any pain but we are not sure what are his wishes? Does he wants this kind of care where we are doing everything possible to keep him alive or he would like something different?what is your view on all this care that we are providing and doctors are prescribing , are you satisfied with it or you are scared from this or would like something else? " I know it is almost going around hot milk but it gives them time to think about it. So , I do not think that we are out of line mentioning other options , and I would like if someone would "protect me" from love of my kids or husband, or stubbornness of my doc if I have to go. God bless