Book of the Month

Our book for May empathetically investigates the extreme life-preserving medical interventions that some patients may choose to decline.Medical innovations have resulted in remarkable lifesaving advances. If a person’s heart or breathing stops, or he or she is unable to eat or drink, hospitals and other medical facilities are often equipped to intervene so that the body can resume the lost function. But for many individuals in declining health, the benefit of such invasive procedures is less clear. To a patient whose goals are to stay put and remain comfortable, these life-preserving measures bring uncertainty about whether the benefits will outweigh the risks and drawbacks (which can include unwanted hospitalization, infection, and insufficient improvement — or even a decrease — in quality of life).

With more than 30 years of nursing home and hospice experience, ordained chaplain Hank Dunn has helped patients of all ages and their families navigate the difficult decisions unique to the final phase of life. Our book selection for May is his guide to making informed healthcare decisions, a straightforward yet empathetic probe of the four biggest choices that patients in declining health can make.

As suggested by the title, Hard Choices for Loving People recognizes how unnatural it can feel to decline lifesaving medical interventions. But Dunn makes a compelling argument that adds dimension and clarity to the purposes of medical care. His introduction alone is worth the read, establishing three separate healthcare goals: to prolong life (or ‘cure’), to preserve function, and to maintain comfort. With the natural progression of advanced age or disease, it may no longer be feasible to cure, at which point the other goals take precedence.

Dunn’s thesis echoes the philosophies of palliative care or hospice, which can still focus on treatment — just not curative treatment. In fact, whether and when to consider ‘comfort care only’ is one of the four major choices the author outlines; each receives its own chapter. The other three decisions are whether to decline resuscitation (such as CPR), whether to decline artificial feeding methods (such as tube feeding), and what treatments a terminally ill patient might allow or refuse (such as a ventilator or antibiotic drugs). Each section cites research on the risks, benefits, and success rates of such treatments, specifically for patients with declining health. Moreover, Dunn offers personal examples of former patients who did not benefit from such interventions — and, on the other side of the coin, some patients who did. Although the author discusses his own opinions, and also shares his spiritual perspective on letting go, his approach is broad enough that readers can consider the options in light of their specific health picture.

In just a few dozen pages, this book discusses late-life healthcare decisions in plain terms, allowing patients to consider their goals and make informed decisions that align with these wishes. For people envisioning future scenarios as part of advanced care planning, or for people facing an immediate decision, Dunn’s open-ended explanations and well-reasoned options can help illuminate the right decisions for them.

Hard Choices for Loving People: CPR, Artificial Feeding, Comfort Care, and the Patient with a Life-Threatening Illness
Hank Dunn
A & A Publishers
80 pages, $6.00