“Sometimes the gentlest of breezes can topple us off the precipice.” While we all know that death is inevitable, it is difficult to accept it as such. Often we search for answers through medical procedures and technologies when the true answer comes from nature, the “gentle breeze theory”. The world of technology and a “fix it” mentality is certainly a blessing, but it can also prove to be a curse. Instead of helping families experience death as a gentle breeze, it creates a stormy and troubled time.

How do individuals and families discern when enough — testing to find the answers to the “why” of decline or illness or the “what” might be done — is enough? How do we recognize when less is more? How can we come to embrace death as a reasonable and even good option, rather than a defeat or a sign that we didn’t do enough? It takes thoughtfulness and a measure of courage.

Clearly, such decisions are among the most difficult. Personal values, the meaning of life, and view of death are critical to decision making, and as important to consider as is medical information. There is no right or wrong, and each individual family must come to peace with it’s own decisions. Some considerations, however, can help a family be more clear and comfortable with their decisions. As tests or procedures are proposed, it’s important to ask:

• “What information will be gained?”
• “How will that information guide care decisions — will it make a difference?”
• “How much discomfort will be involved?”
• “What are the risks of not doing tests?”
• “What are the alternatives to tests and/or procedures?”

Most importantly, information needs to be evaluated in the context of an individual’s life context. An individual who was very active and engaged in life may have the reasons and reserves to withstand difficult treatment and will have a very different recovery than one who was bedridden and whose pre-illness physical and mental resources were near depletion. Ultimately, it’s important to consider: “Will the medical interventions merely forestall death or will they likely provide for a comfortable and meaningful life?”

Very often health care providers are foremost in helping the family with their decisions. It is important that those providers know the person, their history and values, their pre illness life circumstances. While specialists brought in for consultation can give information about tests and procedures, they are often less able to fit the information into an individual’s life context — that is for the regular care provider AND the family to do. Valued friends and ministers or rabbis can be an important sounding boards and sources of guidance.

Choosing to forego tests and treatment is not the same as doing “nothing.” Choosing to accept death and support the dying process is a real and valuable intervention. But doing so can seem foreign and out of sync with a culture that strives to keep aging and death at bay. The opportunity to accompany someone in the dying process can be life giving and comforting. It is an opportunity lost if it is not actively considered as an alternative to treatment. Choosing death can be part of choosing and gracefully accepting all of life.