Time to Go: Three Plays on Death and Dying, with Commentary on End-of-Life Issues

Time to Go: Three Plays on Death and Dying, with Commentary on End-of-Life Issues

Time to Go: Three Plays on Death and Dying, with Commentary on End-of-Life Issues

Time to Go: Three Plays on Death and Dying, with Commentary on End-of-Life Issues

Synopsis

This unusual and timely book presents three prize-winning, one-act plays on the hard choices that patients, their families, and their physicians often face at the end of life. Each play is followed by a critical commentary, with suggestions for staging and follow-up discussions. The introduction provides a lucid and succinct explanation of the human, ethical, and legal contexts for the rights of patients in the United States to make important decisions about their health care. Medical technology has radically changed the way we die; it is now possible to sustain life long after consciousness and intelligence are gone. Although Congress recently passed a law intended to encourage people to create an "advance directive" - a document instructing health care providers what to do in situations where an individual is unable to communicate his or her wishes - surveys show that few people have done so. Time to Go is intended to increase awareness and knowledge about advance directives, and beyond that, to facilitate discussion about the many complicated issues surrounding death and dying today. Besides its interest for the general reader, it should prove useful in the educational and outreach programs of medical and nursing schools, colleges and universities, and civic and religious groups.

Excerpt

In our country's health care institutions, decisions are made every day regarding the use of life-sustaining medical treatment. It is estimated that 80 percent of deaths occur in a hospital or nursing home setting, and that for 70 percent of these individuals a decision is made either not to start or to terminate medical therapy. This scenario is all too familiar to health care workers. A patient with a prior diagnosis of advanced lung disease, metastatic cancer, or AIDS is readmitted to the hospital complaining of severe shortness of breath. Things go from bad to worse, and an urgent decision must be made whether mechanical ventilation will be initiated. The patient is now too ill to comprehend and participate in decision making.

The patient and physician may have had a mutual understanding that the long-term prognosis of the underlying disease process is not good, but the two have not discussed what the patient would want done or not done in the current situation. The physician may have reason to believe this new complication is reversible, but at the same time there is a painful awareness that the patient may remain dependent on the ventilator, even if the underlying lung infection is resolved.

The family is divided, with some members urging the doctor to "Do everything possible"; others saying, "Just make him comfortable"; and yet others, "Do what you think is best." Furthermore, the physician may even fear legal action if he or she withholds or terminates life support.

The site where these end-of-life decisions are made may compound the problem. Patients with life-threatening illnesses such as those depicted above are frequently sent to tertiary care medical centers, with the understanding and hope that they will receive the latest and best treatment available. The "best" treatment has come to mean highly technical and costly therapy that has the potential of sustaining life indefinitely by mechanical and pharmacologic means. In these medical centers, not one but . . .

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