My not-quite sister-in-law is coming to end of her year-long battle with cancer. We’ve known from the beginning there would be no cure, and a miracle was far-fetched at best. Many other members of the family, even 13 months later, still can’t let themselves believe it.
We’re all at an age now that it’s not a matter of if someone we love will become ill and die, it’s more a matter of when. If I can impart any wisdom about the realities of the hardest thing you’ll ever do, it’s this: At the end of someone’s life, especially when they’re no longer capable of making their own decisions, you have to do what’s best for the patient—not what’s best for you. If you’re lucky, you already know what they want and how they want to die.
When my father died more than a decade ago, we knew exactly what he wanted. I can remember being a small child and hearing my father say, “If the only thing keeping me alive is a bunch of machines, turn ’em off.” It was scary to think of a time without him. When the day came, all those years later, it wasn’t easy, but we honored his wishes.
In the case of my sister-in-law and many other people, those wishes haven’t been made clear. The family members left standing have to make hard, painful decisions. Like any other family, they don’t want to imagine a life without their loved one in it.
The decision that’s best for your family is different from other families. I’d be the last person to say that an answer is one-size-fits-all. It’s not, but you’re going to need to be brave and selfless in order to do what’s right. The following are what I believe are the most important considerations.
1. Listen to the doctors and nurses. Over the course of a week, the oncologist and the hospice nurse both asked my sister-in-law if she was ready to stop the chemo treatments. Why? Because they weren’t working. These medical professionals were becoming more concerned for the time she has left because they can see what the rest of us didn’t want to admit to ourselves.
2. If they want to fight, let them. But understand that a dying person can be in denial just like the rest of the family. Urge them to listen to their doctors, but be supportive. This is their life and their future. While it’s feasible, they need to call the shots for their own care. When asked about discontinuing chemo, my sister-in-law decided she was willing to keep fighting for as long as she could.
3. Consider the pain they’re in. My sister-in-law had been in near-constant pain for months. While she had been able to make her own decisions, she decided against most painkillers, fearing that she would become addicted. Now that she’s no longer able to think or speak clearly, it’s up to the family to make decisions to alleviate her suffering. Give your loved one the peace of being as pain-free as possible in their last days.
4. Remember, they’re still adults. If they have all of their faculties and are in their right mind, their wishes trump your wishes unless you have some sort of guardianship. Honor what they want, even if it means they want to die with some grace and dignity before you’re ready to let them go. Give them the best information you can and make sure to ask questions of the doctors so that they and you understand the ramifications of the decisions they make.
5. Be prepared to fight your own family. Even now, when my sister-in-law can no longer walk on her own, when she can barely eat, and as her condition worsens every minute, some family members think she simply needs another MRI or another chemo treatment. Denial is powerful, and when you’re faced with the passing of someone you love dearly, it turns to anger in a heartbeat. Stand your ground with those family members and ask, “Is this what’s best for you or for them?”
6. Let them go with dignity. When it’s time, whenever that moment comes, let them die with grace and dignity. Gather family around them. Let the doctors and nurses take away their pain. Go ahead and cry, rail and get angry, because it’s not fair to lose someone like that. But in the end, don’t allow them to suffer simply because it’s too hard for you, or anyone else, to say goodbye.
The journey to the end of life, especially from a terminal illness, may be the hardest thing you ever have to do. You’re going to need to dig down deep and find a strength you didn’t know you possessed. Let yourself be sad or angry. Let yourself grieve. But when it’s time to make the hard decisions, keep reminding yourself of one thing: Do what’s best for them, not you.
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