But discussing how aggressively an older person wants to be treated remains a conversation — probably a series of them — best held before a crisis.
Intubation, for instance, is often something a physician can foresee. Older patients who have cardio-respiratory conditions (emphysema, lung cancer, heart failure), or who are prone to pneumonia, or who have entered the later stages of Alzheimer’s or Parkinson’s disease — any of them may be nearing this crossroads.
When they do, Dr. Michael Wilson, a critical care physician at the Mayo Clinic, opts for a particularly humane approach.
As he recently described in JAMA Internal Medicine, before he inserts the tube, he explains to the patient and family that while he and the staff will do everything they can, people in this circumstance may die.
“You may later wake up and do fine,” he tells his patient. “Or this may be the last time to communicate with your family,” because intubated patients can’t talk.
Since setting up intubation generally takes a few minutes, he encourages people to spend them sharing words of comfort, reassurance and affection. Without that pause, “I have stolen the last words from patients,” he told me.
His editorial has drawn attention from critical care physicians around the world.
Dr. Wilson has used this approach about 50 times in his I.C.U., so he has learned what patients and families, given this opportunity, tell one another.
“It’s nearly always, ‘I love you,’” he said. “‘I hope you do well.’”