SHOSHANA UNGERLEIDER

done to keep you alive . In many instances that ' s totally appropriate . I am absolutely for intensive care and the use of technology in medical care . I just think that there are instances in which it behooves patients and families to have conversations way upstream from an acute crisis moment where they say — no matter if they ' ve been diagnosed with an illness or not-- " Listen , this is what ' s important to me in my life . This is what gives my life meaning and purpose ." Have a conversation with yourself about that , but then also share it with family , with friends , whoever you consider your loved ones , so that if you end up in a moment in time where you ' re unable to speak for yourself , or even if you are able to speak for yourself , that you have a clear sense of what you really want .

Back in the day , all we did was focus on feel like your health is slipping away from you , you may have a better sense of how to tailor the conversation and discuss it with a healthcare provider . If I ' m hearing , " I ' m having a hard time breathing ," and if it looks as though things will continue to get worse , are you somebody who would want a breathing tube to help you breathe even if it meant you may have to stay on that machine for many weeks or many months or the rest of your life ? I think it ' s very helpful to have these conversations early on and to know that for patients at this point , you have to advocate for yourself if there are specific things that you want and , even more importantly , things that you don ' t want . The medical system has a way of doing things that you really have to aggressively opt out of if you don ' t want those things done .

comfort . We ' ve come so far from a technological perspective and I think that ' s wonderful . We also need to recognize that we aren ' t at a place where we ' re preventing and curing all illness . I hope that day comes , but until then , we need to focus on what to do when a cure does not exist . I think we ' ve forgotten about that in our medical education . As a consumer society we ' re so used to getting everything quickly . We love the magic bullet to make us better . That doesn ' t exist for everything .

Often in a moment of panic , especially when you

There are plenty of cultural and religious factors that play into this conversation . For some people , not doing everything possible to sustain life goes against their core belief system . Who am I to say that that ' s wrong ? That ' s not what I would choose , but it ' s really about making sure that the care patients receive is the care they want and that they ' re fully informed about that situation . I think that it ' s probably too late to have that conversation once somebody is close to the end and in the ICU . You would hope that conversation would have taken place much further upstream . That the conversation had occurred over weeks or months . This is a conversation that needs to be continually

14 | ART OF DYING