Considerations for Dying Patients

Considerations for Dying Patients

June 08, 2015 Editorials

Opinion Editorial by Douglas L. Beck, AuD

The Board of Editors of Scientific American (June 2015) weren’t specifically addressing hearing loss. Yet, as I read their opinion/analysis (page 10) titled “A Last Right for Dying Patients,” many issues and considerations overlapped with what we (physicians and professionals in hearing health care) address daily, and I thought I’d offer up some of their thoughts (and mine) for your consideration.

They note that dying is never easy to confront, but it’s even more difficult in 2015, as we have amazing high-tech solutions that may (easily) prolong life for months or years. The editors of Scientific American note that “many patients would choose not to extend their life this way, but modern medicine does not help them with this crucial decision….” That is, the “vast majority of people in the United States have never had an end-of-life discussion with their health-care providers, or even family members, about trade-offs between extra days and extra comfort….”

Scientific American reports that only 6,500 physicians are board certified in hospice and palliative care (the certification area that focuses on pain relief and end-of-life care). That is a very low number per the 2010 estimate which presumed we needed an additional 6,000 to 18,000 physicians to effectively manage patients in need. They recommend we train a “swath of health-care professionals—generalists, specialists, nurses, and physician assistants….” They also report that medical students spend too little time on these issues and that they should spend more time learning about treating pain, breathing problems, and depression, and how to preserve mental faculties. The article goes on to say and offer more on this monumentally important topic. I recommend their fine article. I have no issue with Scientific American or their report, but ya know…they might’ve missed something. And it’s huge.

As you undoubtedly guessed, one profession of significant importance to dying people, particularly to the oldest of the old, and one profession generally left out of the discussion by physicians and the public (many of whom assume otolaryngology will handle/address hearing issues, despite the fact that 97 percent of all hearing loss in not medically or surgically treatable) is audiology. Seems to me we’re kind of critically important and often invisible during the important hours and days that occur as life ends.

That is, consider the most important words and thoughts and actions that might occur during the last hours of life? Perhaps hearing your loved ones maximally and communicating with them effectively would be of maximal concern?  I’ll bet it is.

Perhaps within the swath of people who need to be trained (and recognized) to address the needs of dying patients, should be those ALREADY addressing the communication needs of the oldest of the old (i.e., audiologists). Arguably, as the number one disability associated with aging is hearing loss (which coincidentally is also the most prevalent birth “defect”), audiologists (and other professionals in hearing health care) need to be included in the recommended swath. Further, if we’re going to talk about depression in the oldest of the old and others, it is well established that people who cannot easily communicate with friends, family, loved ones, and others, exhibit/manifest depression…and for those successfully amplified, depression might be lessened.  

Scientific American closes their article with the idea that people want to share their memories, pass along wisdom, and settle their relationships. I agree. They report people want to die on their own terms. I agree. They report that “When health-care providers help patients attain this, everyone regains a measure of humanity.” I agree. As such, it might be a good idea to send the following message to physicians in hospice and palliative care, pain clinics, as well as family and general practitioners. Communication at the end of life is just as important (perhaps more so) as communication at the beginning of life. 

Douglas L. Beck, AuD, Board Certified in Audiology, is the Web content editor for the American Academy of Audiology and the director of public relations with Oticon, Inc.

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