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