Tell Giselle: Knowing when to give up

“I am helping a relative at the end stage of cancer treatment that has included multiple surgeries, chemo and radiation. No one can say exactly how much longer he has, but however long it is will not be easy on him or the rest of us caring for him. A friend suggests we speak to his doctor to see about how to approach the choice of not holding on much longer, to figure out ways to help him let go.

“I question whether or not this is even our place to speak with the doctor. I want to believe I would want someone telling me it is OK to give up. It isn’t black and white to me. How do we resolve this so we can feel we are doing the best for him?”

G: Here’s what I can tell you that comes from my hospice training: More listening, less talking is a good place to start.

Before a person can even be in a position to “let go” they often want to know that those who love them are “OK” if they “let go.” It may sound strange, but often the dying person is wracked with the guilt of leaving others to grieve and suffer their absence. So, they “hang on” way longer than they otherwise would choose to if they were without supporters who keep urging them to fight on.

If your relative can process such a conversation, begin with getting assurances that their affairs are in order. If they are not, see if you can help facilitate getting the paperwork in place to make for an easier post death process. Even more valuable than helping a dying person to choose to “expedite” their death, whether through their willful letting go or with medical assistance, you can give them this priceless gift.

Helping them prepare for death by attending to all the details that go with this process can be a major task. It can take months and money out of your own pocket. It can put you in the middle of family squabbles, or even a lawsuit. Best not to embark on this unless you have solid legal counsel.

This includes dealing with the paperwork for medical power of attorney, do not resuscitate orders if applicable, a will or trust, and a list of any valuables or other estate concerns. Disbursement of the assets as to specifics of where they would go, taking into consideration where the dying person wants them to go, including any care for pets, are to be spelled out clearly.

I have a particular view of end of life that has come from personal experience that I know challenges many people. When we look at statistics, it is common for seniors in declining health to be either in a hospital or a facility piling up huge bills. It is for care that is prolonging the inevitable, or extending their suffering.

I find this to be cruel. Often the dying person does not have the capability of assessing their condition. They have lost the agency to attain that “good death” we all hope for.

Granted, it is agonizing to let a dying person go. People naturally become highly invested in their own exhaustion and moment to moment trauma. That can cause them to lose sight of what matters most, and can diminish their ability to step up and make the more appropriate decisions for their loved one.

I am not saying anyone should just be eager to “pull the plug” before a medical team assesses the situation. There is a way to face death and do the next right thing despite the pain and uncertainty.

Do engage with your loved one’s doctor. Seek out the case workers, or hospice team, who can assist you to know what comes next.

Knowing when to give up – at any point during treatments or with toxic relationships, career goals, business plans or dreams – is not a declaration of failure. It is an expression of wisdom and one of the greatest gifts of unconditional love we can bestow on ourselves and others.

Another consideration is finances. From my playbook, even for those who can well afford the very finest medical care at the later stages of life, whether it be months long or only days, does not mean that more treatment is the spiritually appropriate choice.

It is likely we have all known people who were weeks from death and saw that they continued with every possible treatment. Even when it was known that the surgery or chemo could not cure them or enhance their quality of life. They insisted, or their loved ones insisted, they “do more”.

They spent their money, or else spent our government’s money through the Medicare system, to live out stretches of what remained of their time on earth in a hospital hooked up to machines and drugs.

Facing end time is a daunting reality many would much rather deny, ignore or battle against. I get it. Still, I prefer people find a heart of philanthropy while they are well enough to know the great good that their legacy and resources can provide.

I advocate for a pivot toward others, rather than to continue to spend money and energy to prolong the inevitable.

Children within a few miles of where you live and work are food insecure, unhoused or living in poverty, and at risk of abuse. Think about the lifting of their suffering. All people of means, however modest, could make end of life choices that bestow upon these innocents any of the money otherwise being poured down the drain on treatments that are pointless.

Children and their responsible caregivers would have more money for their development and education, and a chance at a better life. Have that discussion with all of your loved ones, not just with those who are hanging on by the silver thread.