This document discusses the importance of having conversations about end-of-life healthcare decisions, especially for those diagnosed with mesothelioma. It recommends discussing advance directives like living wills, healthcare surrogates, Do Not Resuscitate orders, and anatomical donations. Having these conversations gives patients a chance to make their wishes known and provide comfort and permission to loved ones. Common fears at end-of-life are addressed, such as being a burden. While difficult, these discussions can eliminate uncertainty and ensure patients' values and preferences are honored.

1. Health Conversations to Have
“Just in case…”
Dana Nolan, MS LMHC
Licensed Mental Health Counselor

2. No One Wants A Mesothelioma Diagnosis
Unexpected health problems are scary.
Many people are uncomfortable thinking or
talking about issues that scare them (aka
“avoidance”).
 Pressure to focus only on the positive
 Human nature to deny our own mortality
 Fear of the unknown (our own death or losing our love ones)
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3. Addressing Healthcare Decisions and
Conversations Head-on
Some cancer patients find comfort in preparing for the
“worst case scenario” by:
Updating their last will and testament
Researching end-of-life care options
Completing a living will
Designating someone to make healthcare
decisions in case of incapacitation
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4. Benefits of Starting Conversations
About Your Mesothelioma
 Gives permission to discuss openly health concerns
between the patient and loved ones.
 Patients wishes and desires are known
 Loved ones have permission to offer their support
and ask questions
 Loved ones can say “I don’t think I can handle
that.”
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5. Common Fears at the End-of-life
Mesothelioma sufferers have shared the
following fears:
I don’t want to be a burden to my loved ones
I am afraid of uncontrolled pain or incapacity
My family will not let me go when its time
I don’t want my family to argue over my care
because they don’t know what I want
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6. Advance Directives
Living Will
Anatomical Donation
Healthcare surrogate
designation/healthcare power of
attorney
DNR (Do not resuscitate)
AND (Allow natural death)
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7. Living Will
Difference between Last Will and Testament and
Living Will
Living Will: Signed and witnessed legal document
which states what kind of medical care you want or
don’t want at the end of your life. Becomes effective
when patient is no longer able to communicate and
make own decisions.
Do not need an attorney to complete a living will.
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8. Living Will (Cont.)
 No one can be forced to complete
a living will.
 Hospitals and nursing homes are
REQUIRED to ask if you have a
living will (or healthcare
surrogate) when admitted.
 If you do have a living will, it is
recommended that your
physicians have a copy so they
can better care for you.
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9. Living Will (Cont.)
 Depending on the state, living wills are known as
“medical directives,” “health care proxies,” or
“advanced health care directives.”
 Some states have a standardized or statutory
form, while other states allow you to draft your
own document.
 Most hospitals have their own Living Will forms
that meet the legal criteria of your state and can
give you a form for free.
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10. Health Care Surrogate
 Also can be knows as a “healthcare
proxy” or “durable medical power of
attorney”.
 A health care surrogate is someone
you have designated to be your
representative to make medical
decisions if you are not able to make
them yourself.
 This must be documented, signed and
witnessed.
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11. Health Care Surrogate (Cont.)
 Don’t need an attorney to complete.
 Recommended to designate a primary health
care surrogate AS WELL AS an alternates in case
the primary surrogate is not available or well
enough to make decisions.
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12. DNR/AND
 “Do not resuscitate” is an agreement between a
patient and a physician that withhold or
withdraw cardiopulmonary resuscitation should
the patient’s heart stop or the patient stop
breathing.
 See Florida’s DNR order (Next Slide).
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13. DNR/AND
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14. DNR vs. AND
 There is a movement within ethics and healthcare
to change the name of a “AND” (Allow Natural
Death).
 Some patients and family members have
unrealistic expectations of CPR when used on a
frail, terminally ill.
 Many physicians who specialize in end of life
diseases have suggested that “allow natural
death” is more realistic and less emotional.
Sourced from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241061/
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15. Anatomical Donation
 Many cancer patients would like to donate their
organs after death.
 Depending on the type of cancer and treatment,
there may be some restrictions on what can be
safely donated. However, it is still safe to be
listed as an organ donor.
 Family and medical professionals will make
decisions about what can be donated at the
appropriate time.
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16. Conclusions
Some mesothelioma patients and caregivers are
reluctant to talk about end of life issues.
Taking the time and finding the courage to do so
can eliminate the anxiety and uncertainty about
what the patient wants if treatment isn’t
successful.
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17. Contact Information
1-800-615-2270
(800) 615-2270