fundamentals
Choices to Make Before Death
Choosing a health care team for end of life care
When choosing a doctor (or a whole care team), a person with a potentially fatal condition (including advanced old age) should ask several questions about care at the end of life: Does the doctor offer to treat symptoms fully (palliative care) at the end of life and provide strong opioids to fully manage pain? Does the doctor have substantial experience caring for dying people? Does the doctor care for the person until death in all settings—hospital, nursing home, or home? Is the doctor flexible enough to accommodate the person’s prioritized treatment options for end-of-life care? Is the doctor familiar with home health, supportive services, and therapy services in the community—who qualifies for them, how they are paid for, and how to help people and families get more intensive services when needed? In some cases, what a doctor may lack in experience is offset by a trusting, long-standing relationship that exists between the doctor and a patient and family and by the doctor’s willingness to consult other experts. A system of care includes a care delivery program made up of doctors, a hospital, a nursing home, and home health care agencies. Systems of care may vary in their costs, insurance reimbursements, and patient deductibles and copayments. Asking questions of doctors, nurses, other patients and families, social workers, and case managers can help a person find the best available clinical team and their network, which makes up a system of care: What treatments are more readily available in different networks? What is the usual practice in providing information about the merits of possible treatments? How can a person talk to other patients and families who have been treated there? Are any experimental treatments available? Does the team regularly attend to patients and families through the end of life? Are they proud of ensuring reliable comfort and dignity and care that matches patient and family preferences? 