Perspectives on Care at the Close of Life: CODA
June 13, 2001

Initiating End-of-Life Discussions With Seriously Ill Patients

JAMA. 2001;285(22):2906. doi:10.1001/jama.285.22.2906

In November 20001 Timothy Quill, MD, discussed the case of Mr B, an 81-year-old father of 6 with advanced pulmonary fibrosis, type 2 diabetes mellitus, atrial fibrillation complicated by a stroke, and chronic renal insufficiency. Drawing on excerpts of interviews conducted in February 2000 with Mr B, his son, and his primary care physician, Dr Quill discussed the obligation of, and rewards to, physicians in opening end-of-life discussions with seriously ill patients, as well as specific strategies for doing so. At the time of the interview Mr B had completed an advance directive indicating that he did not want to be resusitated in the event of cardiopulmonary arrest, stopped anticoagulation and immunosuppressants, and was clear about his wishes to forgo interventions aimed at prolonging his life. Dr G, his primary care physician, described her initial hesitation about broaching the topic of end-of-life care, and her ultimate relief and satisfaction at having done it in a timely manner. Shortly after the interview, Mr B was admitted to a nursing home because of intractable weakness, shortness of breath, and dependence on others for his activities of daily living. Mr B's son was reinterviewed by Amy J. Markowitz, JD, on November 6, 2000. Dr G was reinterviewed by Michael W. Rabow, MD, on November 30, 2000.

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