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Decisions and Factors - Plan For The End
Ernest H. Rosenbaum, MD; Isadora R Rosenbaum, MA; Debra Marks, PhD; Sabrina Selim, MD; Thomas Addison, MD; Joanna Beam, JD; Meryl Brod, PhD; David Claman, MD; Alan J. Coleman, MD; Malin Dollinger, MD; Michael Glover; Nancy Lambert, RN, BSN; Elmo Petterle; Patricia Sparacino, RN, MS, Jeffrey Silberman, Dmin; Kenneth A Woeber, MD

Death is a part of life. We all know that we must die sometime: we just don't know when. Despite this reality, we often think of death as something that happens to other people. Most of us have a difficult time accepting our own mortality, and won't even think about it until a crisis forces us to do so. Even then, we may fight and bargain to gain more time.

Accepting death is an issue for doctors as well as for patients. Because our society views death as a failure or point of giving up, many doctors fight to preserve life at almost any cost. The consequences of lost time or money, as well as the emotional strife of both patients and family may not be fully considered when assessing whether to keep a patient alive. This may be confusing and frustrating to a patient who wishes to die a dignified and peaceful death but cannot express it. Advance Directives help to avoid these situations in which the medical team's and patient's wishes conflict.

Factors that May Influence your Decision
How we live our life and how we plan for our death are personal choices. Society also influences us as we observe the attitudes, ceremonies and rituals that surround death and dying in our culture. For guidance in these important decisions, many of us seek religious or spiritual advice.

Since the late 1950s, advances in medical technology and medical practice have changed how patients, lawmakers, physicians, ethicists and society in general think about and define life, death and dying. We may have watched how others have reacted to the death of a loved one. Many of these changes have resulted in serious ethical dilemmas for the medical profession, causing doctors to reassess their role in caring for patients. Patients and their loved ones, faced with the possibility of prolonged suffering and delayed death, have been asking for the power to make their own decisions and to die naturally with dignity. Each person should know about his or her choices for discontinuing aggressive treatment with respect to the newer ethical and professional dilemmas.

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