[Skip to Content]
[Skip to Content Landing]
Views 5,297
Citations 0
Less Is More
May 28, 2019

The Last Breath—Enriching End-of-Life Moments

Author Affiliations
  • 1Department of Medicine, Weill Cornell Medical College, New York, New York
JAMA Intern Med. 2019;179(7):865-866. doi:10.1001/jamainternmed.2019.1451

I was getting ready to go to work when my sister called from Winnipeg. “Mom is dying,” she said. Our mother was 90 years old and had experienced a stepwise decline over several months after an episode of urosepsis, complicated by recurring episodes of aspiration pneumonia, Clostridium difficile diarrhea, and a pelvic fracture. She became less interactive with each complication. She had been clear in her instructions to us that she did not want to be kept alive if she was unable to interact meaningfully with those around her. We communicated to her clinicians that she was not to be resuscitated in the event of cardiopulmonary arrest. A few weeks after that, we moved her to a skilled nursing facility, understanding that it was inevitable that she would have further episodes of aspiration. A week later, she developed a fever and was given oral antibiotics for several days. A week after completing the course of antibiotics, she developed a fever again, so the antibiotics were restarted.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    5 Comments for this article
    Prayer at end of life
    Brenda Hocutt, Mrs, Mom, Mimi, Dada | Med-Mal Defense Paralegal
    I can think of no more meaningful activity for the family to participate in at the death of a loved one than prayer. Thank you.
    Enriching end of life
    Ricardo Franco, MD | University of Alabama at Birmingham
    Wonderful piece. Many thanks to you and your family for sharing.
    An experience similar to that of the author of the article.
    Rigoberto Marcano, Internal medicine | Medicina Preventiva Santa Fe, Caracas
    Many years ago I witnessed the death of a patient who had a daughter who was a nun; in her last moments, she sang to her father until the moment of his death, something I had never witnessed before; an experience similar to that of the author of the article.
    Always something to offer at the bedside
    Pablo Garcia, Geriatrician | Casa de los Ángeles, Guatemala
    Beautiful description.  For physicians, there is always is something to offer, not only in medical terms...also in spiritual terms.  "Patient centered care" is a good approach.
    Physicians can be part of the problem
    John Weiser, MP, MPH | Family physician
    Wise advice. But families are sometimes willing to forgo futile interventions while physicians promote them. My mother-in-law recently died during heart surgery but was kept "alive" for another week with a ventilator, ECMO, balloon pump, pacemaker, high dose pressors, and dialysis even though her heart never contracted and she never woke up. Now it is the family, not the doctors, who live with guilt for not being able to protect her.