Reducing Optimism Bias at End of Life

In the New York Times article, “Aggressive Medical Care Remains Common at Life’s End”, emphasis was placed on carrying out a patient’s end of life wishes no matter how much loved ones may want to hold on to hope. The story centers on Jennifer O'Brien, who’s 84-year-oldfather James, who had broken his hip while he lived alone. James had standing do-not-resuscitate (DNR) and do-not-intubate (DNI) orders, Ms. O'Brien said. They had discussed his strong belief that "if his heart stopped, he would take that to mean that it was his time." Her father, who wasn't cognitively impaired, had decided that surgery was "silly" and unnecessary. Despite this, Jennifer still had to convince an anesthesiologist and orthopedist that performing surgery at this point in his life, would not improve his quality nor quantity of life.

The story of James O'Brien is a reminder for me as a practicing physician, of the importance of having difficult conversations about end-of-life care. For many of my stroke patients, and myself as their physician, these conversations can be uncomfortable, but they are essential to ensuring that patients receive the care they want and need.

In addition to having difficult conversations, it is also important to plan for end-of-life care. This includes creating an advance directive, which is a legal document that outlines your wishes for medical care if you are unable to make your own decisions. You can also designate a healthcare proxy, who will be able to make decisions on your behalf if you are unable to do so.

Planning for end-of-life care is not something that anyone wants to think about, but it is important to do so. By having these difficult conversations and putting plans in place, you can help ensure that your loved ones receive the care they want and need at the end of their life.

The most important thing is to start the conversation. It may be difficult, but it is the best way to ensure that your loved ones receive the care they want and need. Reach out to your health provider to learn how you can start your plan.

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