When is it time to discuss death with your oncologist?

[Darryl]

Dr. Hans M. Westgeest is a medical oncologist at Amphia Hospital, Breda, the Netherlands. He is the coordinating researcher of CAPRI (CAstration-resistant Prostate cancer RegIstry) youtu.be/wwvQXJo2aJE(Not working as expected?)

[maggiedrum]

Darryl, I am glad that you had and posted the discussion you had with Dr. Westgeest. I have seen one or two other interviews/discussions with him and he speaks directly about issues but with empathy and compassion.

I want to have the type of discussion with my primary care provider and with my oncologist as well. It is something that I am prepared to deal with. I have had preliminary discussions with my wife. I keep her informed about my condition, prognosis, and potential therapies, which, in my case aren't very many.

I really hate being in a hospital. They are the least restful place you can be. Nurses are always coming by all during the night to check your vitals or those of patients in your room or in other rooms nearby. And often they talk very loud in the hallways even. The food is lousy. It is always worse if you are in an ICU. It is not, for me, a plus in my QoL.

Another issue is whether your state or country or hospital will allow death with dignity. Many of the hospitals in Washington state are owned and operated by Catholic organizations. The do not believe in death with dignity and will not allow any of their doctors to support it either. But, at least one should have their wishes formally written down and even notarized and signed by their doctor as a witness if they can.

In my mind, discussions about this should be done with before one loses their ability to give "informed consent". If you are on opioids I believe that you might not be considered to be able to give informed consent should the hospital, or provider, or one of your family members want to dispute it. My wife and I both have written down and signed our wishes for treatment when the our lives are undisputedly terminal in the very near future. Some states have tried to put death with dignity in the state laws. But even when that is the case it is sometimes (often actually) difficult to go that route with so many others don't want that option possible.

I also don't want to bankrupt my wife by getting treatments with extremely low odds of being able to extend my life, especially when they have the effect of severely ruining your QoL. I don't want to have my wife watch me go out as a vegetable under heavy doses of opioids or in agony or just plain distress from therapies with really nasty side effects.

These are just my personal thoughts and others will feel differently. Darryl it is great that you have posted your interview to give some of us more motivation to have these discussions and make some significant decisions about the rest of our life before we are not able to.