Discussion Questions for

Last Wish: Stories to Inspire a Peaceful Passing

By Lauren Van Scoy, MD

Discussion questions prepared by Alicia Marini Bloom, MSW LSW

VITAS Innovative Hospice Care

Alicia Marini Bloom, MSW LSW is a masters-prepared, licensed social worker that has been practicing in hospice & palliative care for over six years in both the inpatient & outpatient settings. Currently, she works for VITAS Innovative Hospice Care—the nation’s leading hospice provider. In her role, Alicia has the privilege of providing direct care to patients and their families, and focuses on clinical education of healthcare providers and the community at large about hospice and palliative care to increase access and utilization of critically important services to people living with serious illness and their families. A graduate of the University of Pennsylvania with a BA in Sociology and a Masters of Social Work, Alicia is published in the International Journal of Palliative Nursing for her experience as part of a clinical team that developed and implemented a palliative care educational program at the University of Botswana. She is also published in the Journal of Palliative Medicine.

A Biker’s Heart

1.  Bruce was in a state of near death for many months and endured many invasive procedures prior to getting his heart transplant.  What were the trade-offs for Bruce and his family as they continued full aggressive medical therapy? What sacrifices did he make in order to survive his illness? 

2.  Bruce was a middle aged, strong and healthy man prior to his life threatening illness.  Consider how a person’s condition prior to serious illness influences their ability to recover.  How should this impact decisions made about invasive and aggressive medical interventions?

3.  What would you be willing to give up in order to survive a life-threatening illness (discomfort, independence, ability to eat, walk, etc)?  What would you not be willing to sacrifice?

Breathless

1.  How did you feel and what emotions did you experience when reading Mrs. Chandler’s story?

2.  Much of Mrs. Chandler’s story could have been different if she and her family were more prepared for the terminal nature of her illness.  Why do you suppose there was so much conflict and turmoil surrounding her end-of-life experience? Consider the role of a living will or advanced directive?

3.  Lisa and Sam had difficulty recognizing that Mrs. Chandler would not recover from her terminal cancer. What role does hope serve for families facing terminal illness or the impending loss of a loved one?

4.  Lisa and Sam’s religious faith influenced the medical decisions they made for their mother. Consider and discuss the role of faith in medicine and science.

5.  Lisa said that Mrs. Chandler wanted “to live.” Think about what “living” and quality of life mean to you. How would you want to be cared for if you were in Mrs. Chandler’s situation? What would you want your family to know?

A Courageous Choice

1.  Patrick knew where his “line in the sand” was and courageously faced it—where is your line in the sand? Why is it important to communicate your wishes to your family and how might you go about doing so?

2.  Were you surprised to hear Patrick ask his physician about hospice? What was your initial reaction about Patrick enrolling on hospice? Was his experience what you expected? Would you feel comfortable discussing hospice with your physician if you had a terminal disease? Why or why not?

3.  Although Patrick was young, his story shows us the reality of people living with chronic, yet ultimately terminal illnesses. What did you learn from Patrick’s experience?

The Heart of the Matter

1.  Why do you think it was hard for Walter’s parents to understand to that he was dead, but still had vital signs on the monitor?

2.  Once the doctors declared Walter brain dead, his parents had no end-of-life decisions to make, even though his heart was still beating.  Why is this situation so unique?

3.  How did you conceptualize the moment of death prior to reading Walter’s story?  How did his story change your perception, if at all?

The Hospice Bride

1.  After reading Barbara’s story, did your perceptions of hospice care and its benefits change and if so, how?

2.  There are many misconceptions about hospice care.  Think about and discuss how Barbara’s experience is contrary to the following misconceptions:

a.  Hospice care means stopping all medical therapies and medications.

b.  Being on hospice means you’re giving up.

c.  People who enroll on hospice always die within a short period of time.

d.  Hospice is very expensive.

3.  Some say hospice is a way to die, but Barbara says that it is instead a way to live.  How do you feel about the idea of hospice care?

A Peaceful Passing

1.  Victoria’s family was faced with an unexpected decision in a crisis situation. What would you have done if you were her daughters?

2.  Ultimately, Victoria’s family was guided by her values and preferences when it came to medical decision-making—what would you want your family to consider?

3.  Modern medicine can keep the human body functioning in the setting of very serious illness, however just because we can intervene, does it mean we always should? What are the costs to patients, their families and the healthcare system?

The Last Wish Compass

1.  Why is it so difficult for patients, families and clinicians to initiate end-of-life discussions?

2.  How is the Last Wish Compass (page XX) different than a typical advance directive (page XX).  What does the Compass cover that goes beyond information in an advance directive?

3.  Why might the Last Wish Compass be a useful addition to an advance directive or living will?

General Questions

1.  What inspired you to read Last Wish?

2.  Do you have any personal stories or experiences with critical illness or end-of-life care? How did this experience affect you?

3.  Have you ever considered the way you would want your medical care handled if you were seriously ill?  Why or why not?