End of Life Issues
Ending Treatment
The choice of when and if to end treatment is yours and may depend on your idea of quality of life. It can be reassuring to know that if you choose to discontinue treatment, you have the right to change your mind. In addition, if you do not continue medical treatment, you have the right to receive medications that control your symptoms and pain with palliative and hospice care.
This decision is often made in the context of changing goals. For you, time may not be as important as quality of life, or you may want to stop treatment for a while to take that important trip and feel good while traveling. This decision is not easy, but as long as you are living, you can always change your mind.
Preparing for Death
Considering one's own death is sad and frightening. Everyone handles death differently, and you may feel that you are not ready to consider your own. This is quite normal; most of us feel exactly the same way. However, some women with metastatic breast cancer feel that in fighting cancer, they are fighting death and have confronted it in a very personal way. To them, dealing with their own mortality is unavoidable and is a necessary part of continuing to live.
There are two distinct aspects of dealing with death. One aspect is working through the emotions and feelings that you have about dying. The other aspect is handling some of the practical aspects of your life so that if you are unable to express your wishes about how you would like to die, your choices will be known. In addition, dealing with the practical aspects of death also involves expressing your preferences as to what should happen after you die.
Practical Aspects of Preparing for Death
It helps to handle practical issues before becoming seriously ill. Some of the considerations that women with advanced breast cancer have dealt with include:
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Preparing a living will, which describes when life-saving treatment should and should not be given and the point at which the maintenance of life should end
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Preparing a durable power of attorney for health care, which allows the patient to name a person who will able to make decisions about their treatment when they are not able to decide for themselves
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Making custody arrangements for young children, which is especially important for single mothers
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Writing a will, which outlines who should receive your possessions and property (if you do not write a will, the state decides the disposition of your possessions)
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Planning funeral and burial arrangements to let family members know how you would like to be remembered
There are many important care options that you may consider as you become seriously ill and need continuing treatments. Many women feel that they would rather be at home if they are gravely ill and prefer to die at home than in the hospital. Home care services that can arrange for 24-hour nursing and medical equipment to be brought into your home are available. In addition, many patients and families have found palliative care or hospice care to be a positive and supportive experience.
Feelings and Fears About Death
Most people with advanced breast cancer have told us that they are not afraid of death itself, but of how they will die. Women often said that their greatest fear was being in pain or dying alone. These are very common fears, and it helps a lot to share these fears with your medical team and your family. Solutions can be identified to resolve your fears by discussing them and planning for certain events.
Most people expect that death occurs in an instant, leaving no person the opportunity to know what is happening. This is most often not the case. When someone dies of cancer, physical stages of slowing down over a series of days or weeks are easily recognized by a health care professional or trained caregiver. In most cases, these individuals can alert family and friends in enough time so that they can be with you as you go through the process of dying.
Information excerpted from I Still Buy Green Bananas: Living with Hope, Living with Breast Cancer
