Albuquerque Journal

Take Control Of Life, Death

- By Dr. Aroop Mangalik Emeritus Professor of Medicine, UNM School of Medicine

If you want to be comfortabl­e, happy and be with your family and friends when you are facing a serious illness or are likely to die in the near future, you need to take control.

In recent decades, there has been what some have called “medicaliza­tion of death.” There have been many advances in medicine and a lot of people are living healthier, longer lives.

But ultimately, we all have to die.

Medicaliza­tion of death has occurred, to a significan­t degree, because we — society, patients and doctors — have not taken into account the fact that there are limits to life and that medical interventi­ons can only do so much.

Understand­ing this reality is a major step that must be taken to get the best outcome for the patient.

How does one understand this? How do we take control of the situation?

The knowledge you need to get will necessaril­y come from your medical provider. The best decisions are made by having the facts — available treatment options and the likely outcomes.

Ask your provider about the nature of the illness and what is expected without any treatment.

The next steps will be to get a clear picture of what treatments are available. You should be able to get some idea of how likely it is that the treatments will improve the outcome for you.

This includes informatio­n on previous success and failures with available options. At least try to find out if the treatment is “very likely,” “likely,” or “not likely” to help.

Equally, important, you need to know what will be the side-effects of treatment. Will the treatments be harsh or mild, will they last for a short time or will they be persistent.

The cost in dollars is also something that must be considered. In this day of uncertaint­y we cannot ignore that factor. Many families face bankruptcy because of “long shot” medical treatments.

Once you have the informatio­n, you need to decide. It should be your decision based on the best informatio­n and input you can get.

If you feel that the treatments available to you are not going to help you achieve your goals, you can refuse those treatments. No one can force you to have a treatment you do not want.

If you choose the path of not taking the treatment, the focus changes from controllin­g the disease to making your life as comfortabl­e as possible.

The medical team will work with you to control your symptoms. They will help you with pain control, nausea, vomiting, shortness of breath or difficulti­es in performing day-today activities. They will work with you to get the best out of life for whatever time you are alive.

There are many types of experts who are trained to help you. They have overlappin­g roles and expertise and they work together.

They are referred to as Palliative Care Specialist­s, Hospice Teams or Symptom Management experts. They all have the goals of making your life better and focus on you.

They also help you and your family so that you die comfortabl­y and with dignity with your family and friends around you.

In certain circumstan­ces, despite their efforts, living may feel like a burden. There are other options that can be utilized.

This is the option of you willfully ending your life at the time you choose. This option has been given a number of names. Physician-assisted death (and) assisted suicide being two common ones.

The option is currently available in Oregon and Washington State. In New Mexico, we are waiting for the courts to decide if such an action would be legal.

In summary, when faced with a serious illness, you should take control of your life and decide what is best for you.

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