Palliative Medicine for Serious Illness: Living Your 'Bucket List'

Dr. Ira Mandel MD, MPH, is Medical Director of Pen Bay Healthcare’s Hospice and Palliative Care program

In 2007, American audiences resonated with the story of two terminally ill men who escaped from a hospital cancer ward to take a road trip with a wish list of to-dos before they died. The movie, “Bucket List,” starred Jack Nicholson and Morgan Freeman. The movie’s lesson was that they did not have to spend their final weeks and months of life hooked up to IV poles, nor deal with side effects of treatments that were unlikely to improve the quality of their lives. Instead, the men decided to leave the hospital and experience all the things they ever wanted to do before they died, according to their “bucket lists.” In the process, they healed each other emotionally, became unlikely friends and ultimately found joy in life.

Most people with advanced illness can’t travel the world like the movie characters, nor would they desire to if they could. Instead, if little time is left, most people seek to spend time in the comfort of their own home with their family, pets and friends. United States public opinion surveys consistently find that the majority of Americans would rather die in their own home during their final days than in a hospital or in a nursing home.

A recent study published in the Journal of the American Medical Association (JAMA – “Change in End-of-Life Care for Medicare Beneficiaries,” February 6, 2013) found that increasing numbers of terminally patients are spending more of their final weeks of life in the hospital. Survey results showed that in 2009, patients spent more of their last 30 days of life in the Intensive Care Unit than in the past.

While more of these patients were also referred to hospice care that enabled them to go home, it was common practice to wait until the last one, two or three days of their life for such a referral. This delay ultimately deprived patients of meaningful time they have said they would have preferred to spend at home.

How can you and your loved ones spend your final weeks of life living your “bucket lists” if your condition is rapidly declining?
• Talk to your family in advance and make sure they know how you would like to spend your time at the end of your life and how they would like to spend their time. 
• Share each of your “bucket lists” with each other.
• Write your wishes down in a “living will.”  Visit: www.pbmc.org/livingwill.
• Don’t be shy when facing a serious illness. Let your doctor know how you or your loved ones want to spend the end of life if it is approaching. 
• Finally, ask your doctor to be honest with you about how effective treatments will be when you or your loved ones are facing serious illness. Most doctors are uncomfortable giving “bad news” if the chances of meaningful recovery are not good. If you encourage them, doctors will not hide details about treatment effectiveness but will aid you in making the best decisions for yourself and your family.

Your life is too precious to slip away in the Intensive Care Unit if you could be spending your time in better ways. Palliative care and honest, early communication can help you live your “bucket list!”

Ira Mandel, M.D., MPH is a Palliative Medicine physician and is medical director of Pen Bay Healthcare’s Hospice and Palliative Care program. He provides compassionate care with a team of health professionals who honor the wishes of patients with serious illnesses. His monthly column seeks to inform the public about choices they may wish to consider. Disclaimer: All people described in this column are not actual patients but are derived from many hundreds of patients Dr. Mandel has treated over many years.