Communication Is Essential to End-of-Life Choices

September 17, 2020

Only 17% of all patients surveyed have had conversations with their physicians about the end of life, experts reported. Nurses can help normalize the process of dying and facilitate such conversations.

Nancy Niedzielski, MBA, BA, is a representative for End-of-Life Washington, an organization that works to elevate the standards of end-of life care. She explained that End of Life Washington helps patients in areas that nurses may already be familiar with:

Medical Aid in Dying

DWDA allows a terminally ill adult who meets a set of established criteria to request and receive a prescription for medication that he or she may choose to take to bring about peaceful death. Niedzielski encouraged nurses to use the appropriate terminology for the process: medical aid in dying (MAID). “Words matter,” she urged.

In addition to Washington State, Oregon, California, Montana, Colorado, Maine, Vermont, New Jersey, Hawaii, and Washington, DC, have varying laws that permit MAID. Many other states are considering legislation.

To qualify for Washington state’s DWDA, a patient must:

Patients and physicians must follow a particular process and timeline, and the physician is responsible for reporting requirements. The process varies by state, but in Washington, it involves:

Importantly, a patient may rescind his or her requests, and the DWDA protects life insurance coverage. Healthcare providers also are protected, and an employer cannot prohibit employees from helping patients off premises or off hours.

Communicating End-of-Life Wishes

Niedzielski said that about 70% of people do not have an advance directive in place. She encouraged nurses to create their own and support their patients to do the same. An advance directive should be signed by witnesses, notarized, and updated regularly.

She reviewed several types of advance directives, as well as their pros and cons:

In addition to an advance directive, Niedzielski said that each person should select a primary healthcare agent and an alternate, then communicate with them clearly about their end-of-life wishes.

A healthcare agent should be someone who:

“It’s important to know all your healthcare options and to put your wishes in writing through an advance directive, regardless of age or health,” Niedzielski said. “Our goals at End-of-Life Washington are simple: that no one dies alone, that no one dies in pain, and that no one pays a fee for our services.”


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