All posts by gabbert2013

About gabbert2013

I have been a psychotherapist for 20+ years. I specialize in Marriage & Family Therapy and addictions. My practice name is Interactions Therapy Center. I've learned a few things over the years and hope you'll find these blogs interesting.

Can You Be Overly Empathic?

Empathy is the capacity to understand or feel what another person is experiencing. It is placing oneself in another’s position. This is a desirable trait in that it causes people to help others in need. It improves relationships. It can reduce feelings of bigotry, racism, sexism, and all other types of intolerance. Positive empathy improves health. But is there a down side?

Individuals differ in their ability to feel empathy. Psychologist Simon Baron-Cohen describes an empathy scale from zero (having no empathy at all) to six (an unstoppable state of empathy for others). Empathy comes at a cost to people at the high end of the spectrum. They are more prone to suffer depression and anxiety. Compassionate helping is good for you and for others. But taken too far, it can be destructive.

I know of a woman who is generous, thoughtful and kind. She has strong empathy skills, particularly toward children and animals. She is attuned to pain and discomfort to a degree that is often debilitating. If she sees an injured animal, she is likely to have a panic attack. Her empathy often causes emotional fatigue and tearfulness. This high sensitivity to others causes her to restrict her viewing of TV shows and movies that may have disturbing content. In short, it negatively impacts her quality of life.

Females tend to be more empathic than males. Women are better at recognizing facial effects and emotions in general. Research suggests that empathy is also partly genetically determined. Empathy is also correlated with high levels of oxytocin, a chemical in your body that acts as a neurotransmitter, or messenger between brain cells. A study by Paul Zak, neuroeconomist, demonstrated that people are more generous and more trusting when given doses of oxytocin.

Is empathy learned? Yes. One study found that parenting style contributes to the development of empathy. Parents who encourage the child to imagine the perspectives of others and teaching the child to reflect on their own feelings develops empathy.

Can you lose the ability to be empathic? Empathy can be disrupted due to trauma in the brain such as a stroke. For example, empathy is often impaired if a lesion or stroke occurs on the right side of the brain. And damage to the frontal lobe, which is responsible for emotional regulation, can impact a person’s capacity to experience empathy toward another person.

How empathic are you? Baron-Cohen developed a 60-item questionnaire, called the Empathy Quotient (EQ) designed to measure empathy in adults. You can take the questionnaire at https://psychology-tools.com/empathy-quotient.

As in most things in life, balance is key. If you find that you are empathic to your own detriment, you may benefit from counseling techniques designed to keep you grounded and focus on your own emotion regulation.

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What Comes First – the Disease of Addiction or Addictive Behaviors?

Here’s a chicken or egg question. Which comes first? Does the disease of addiction lead to habitual behaviors (such as drug use), or do habitual behaviors (like drug use) cause addiction?

Addiction is largely genetic, according to author Howard Wetsman of Questions and Answers On Addiction. He says that “something on the order of 70% of the variance of who becomes an addict is explained by their genetic makeup.” A family history of addiction may predispose you to habitual behavior. In a sense, it creates a brain condition in which you feel better when using a substance. The biology of addiction is in the brain, not the body, although the symptoms are expressed in the body.

In what way is addiction a brain disease? The brain functions differently in people with an addiction.
• There are many ways that the brain is affected, but dopamine is a primary factor. Dopamine creates the feeling of pleasure. Drugs take control of this system, causing large amounts of dopamine to flood the system. This flood of dopamine is what causes the “high” with drug use. With repeated drug use, the brain starts to adjust to the surges of dopamine. Neurons may begin to reduce the number of dopamine receptors or simply make less dopamine. Because some drugs are toxic, some neurons may also die. As a result, the ability to feel any pleasure is reduced. Now the person needs drugs just to bring dopamine levels up to normal.
• With drug use, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it.
• Addiction increases the brain’s reaction to stress. Brain circuits become overactive, making people feel very stressed when they aren’t using drugs causing “cravings.”
• Additionally, addiction weakens the prefrontal cortex. The prefrontal cortex powers the ability to think, plan, solve problems, make decisions, and exert self-control over impulses. This is also the last part of the brain to mature, making teens most vulnerable.

Wetsman would say the remaining 30% of people who become addicted to a substance do so through repetitious drug use. They may not be genetically predisposed but enjoy recreational drug use that spiraled out of control. Or others may have become dependent on a substance unwittingly as through a medical prescription.

If it is true that addiction is a disease and predates habitual behavior, it would explain why some people would describe themselves as having an “addictive personality.” They have a tendency toward habitual behaviors that may be expressed through alcohol, drugs, food, gambling, sex, etc. The disease of addiction also explains why many people switch their preferred addiction after recovery. Hypothetically, some people may stop cocaine use and start gambling. Recovery is not simply the absence of drugs or alcohol. Ceasing the substance is only the beginning, or they may fall prey to switching the addiction.

So, in your experience of people with addictions, which came first, the chicken or the egg?

Age Is More Fluent Than You’d Think

We are often defined in terms of a magic number. We often ask children their ages. Dating sites are based upon ages. Age is often published immediately after a name in a newspaper obituary and in coverage of criminal charges.

You can legally change your name. You can change your gender. But you can’t change your age. Or, can you? Emile Ratelband, a Dutchman has asked a court in the Netherlands to legally change his age from 69 to 49, saying he wants to avoid age discrimination. Ratelband says his age is unfairly holding him back, but he doesn’t want to lie about it. For example, when he asks for a mortgage, he is denied. If he goes on a dating site, he doesn’t get responses. “With this freedom of choice, choice of name, free-ness of gender, I want to have my own age. I want to control myself,” he said. Having his age legally changed would offer him inspiration and hope, he said. He would give up his monthly pension if his request is granted. A court is expected to issue a ruling in about four weeks.

Age is not a good indication of who we are and it should not define our self-image. There are mature children, and immature adults. There are people who appear 70 who are in fact 50, and vice versa. There are mixed aged couples who are very compatible.

How we age is largely beyond our control but is primarily influenced by genetics. Interestingly, one study found that certain parts of the body age faster than others. For example, breast tissue is some of the oldest tissue in the body. Even healthy breast tissue can be as much as three years older than the rest of a woman’s body.

Chronological age refers to the actual amount of time a person has been alive. It does not change, regardless of their health, exercise and nutrition. Everyone ages at a different rate. Some people age rapidly, while others age more gradually.

Biological age, on the other hand, is also referred to as physiological age and does consider lifestyle, diet, exercise and sleeping habits. Your functional biological age is the age of your body’s systems. This takes into account one’s blood pressure, respiratory capacity, aerobic power and blood glucose levels.

Your psychological age can be broken down into cognitive functioning (your ability to learn and remember) and emotional functioning (your ability to handle and manage your feelings). As we age, we tend to have difficulty with some aspects of memory. Yet, we cope better with emotions as we age.

Social age reflects a continuum on major life markers such as when we graduate from high school and enter the workforce (approximate age 18), start a family (approximately 20s to 30s), or retire (approximately age 65). We make assumptions of people’s age based on these social markers. However, your social age may be much younger or older than the norm. You can become a first time parent in your 40s or 50s. You can retire early at age 25, such as having had a lucrative sports career.

Susan Krauss Whitbourne suggests you ask yourself a simple question: How old do you feel? “Forget what the calendar says, and even forget what your functional ages are. The age you feel may very well be the most important factor determining your health, happiness, and longevity.” Whitbourne consistently found that the people who are the happiest and best adjusted in their middle and later years are the ones who don’t focus on their limitations, worry about their memories, or become preoccupied with whether others view them as old.

How old do you feel?

How Much Do You Like to Help Others?

Altruism is the unselfish concern for other people; doing things simply out of a desire to help, not because you feel obligated to do so out of duty, loyalty, or religious reasons. Pure altruism involves true selflessness.

We don’t often think of animals as altruistic. However, there are many incidences of animals engaged in helpful behavior to others. For example, we adopted a puppy who immediately bonded with our middle-aged Labrador Retriever. They each enjoyed a nightly raw hide bone. However, the raw hide was too tough for the puppy, so the Lab would chew it until soft and then they would trade bones. This developed into a nightly ritual in which they would chew their bones, the puppy would release his bone and bark, and they would then switch. The Lab was truly altruistic. He got nothing in return for softening the other’s bone. However, years later when the Lab lost his hearing from old age, the younger dog would alert him to sounds by touching his nose.

According to Kendra Cherry, MS, author of The Everything Psychology Book, there are a number of theories for why altruism exists. There are biological reasons in which altruism toward blood relatives increase the odds of gene transmission to future generations. There are neurological reasons in that altruism activates pleasurable reward centers in the brain. There are social expectations or norms that influence kind behavior. For example, we feel pressured to help others if they have already done something for us according to the norm of reciprocity. Researchers suggest that people are more likely to engage in altruistic behavior when they feel empathy for a person who is in distress. And helping relieves negative feelings. Seeing another person in trouble causes us to feel distressed, so helping them reduces our own negative feelings. Most often people behave altruistically for selfish or hidden reasons. But sometimes people exhibit altruism even when it does not benefit them.

Some people step up to help others at the risk of their own peril. Why would some people risk their own lives to save a complete stranger? For example, more than 100,000 people in the US today are waiting for a kidney transplant. About 200 extraordinary altruists unconditionally donate their kidneys to people whom they don’t know and will never meet. What’s different about these people?

There is research to suggest that brain function and structure play a part in these actions. Professor Abigail Marsh of Georgetown University has studied altruism. She conducted research on 19 people who donated a kidney to strangers. They performed psych testing, brain imaging, gathered background information, but none of these indicated a difference from the control group of people who had not donated a kidney. One difference however, was found in a part of our brains called the amygdala, which is called the emotional center of the brain. They found that the amygdala was significantly larger in altruists compared to those who’d never donated an organ. The amygdala in altruists is supersensitive to fear or distress in another’s face.

Think of altruism on a spectrum with psychopathy. Psychopaths comprise 2% of the population and are primarily motivated by self interest. They have traits of callousness, manipulativeness and a lack of guilt or remorse. Psychopaths have smaller, less active amygdalas. The brain’s emotional radar in psychopaths was blunted and unresponsive to others’ distress or fear.

If such small percentages of people are either psychopaths or pure altruists, most of us are in the middle. Where do you think you fall on the spectrum between pure altruism and psychopathy? Although you can’t change the size of your amygdala, if you value altruism you can purposefully practice acts of kindness. The world will be better because of it.

Don’t Take a Squirrel on an Airplane

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Earlier this month a squirrel was denied a flight from Orlando to Cleveland. The owner boarded the airplane with the squirrel in its cage after declaring an emotional support animal on her reservation. The squirrel cleared the x-ray machine. Her mistake was that she hadn’t informed them that her emotional support animal was a squirrel. Once onboard, she was told that squirrels are rodents and are not welcome by Frontier Airlines. The owner refused to get off the plane and everyone was deplaned while police entered. The owner then got off and no further action was necessary. The other passengers made their displeasure known after a two-hour delay. Problems with animals on board have caused many airlines to tighten regulations.

As a psychotherapist, I am called upon to soothe emotions and decrease anxiety. Sometimes a pet can perform the same function. I’ve recently had two people ask me to write a letter stating that their dogs are emotional support animals. More and more emotional support animals are boarding planes. Pigs, peacocks, miniature horses, kangaroos, possums, parrots, ducks, turkeys, lizards, and turtles are boarding planes in addition to cats and dogs. The Air Carrier Access Act prohibits commercial airlines from discriminating against passengers with disabilities. Individual airlines have policies that bar some of these creatures from boarding.

Emotional support animals are companion pets who provide benefit for an individual with a psychological disorder. They differ from service animals, who provide an actual service such as guiding someone who is blind. To fly with an emotional support animal, a passenger needs a letter from a doctor or mental health professional describing the emotional benefit the animal provides for their particular disability.

Our pets become friends and family members. It is with great reluctance that people relocate to a home that won’t allow their fuzzy friend. The Fair Housing Act allows reasonable accommodations be made for people with disabilities. Some people misrepresent themselves as having a disability that only their pet can improve. This behavior makes it more difficult for people with verifiable disabilities to get the accommodations they need.

We all love our pets and find comfort in their presence. In fact, the act of petting can lower blood pressure, help your body release a relaxation hormone, and cut down levels of a stress hormone. Walking a dog is good for the heart. Pets can help you connect with other people. It is easier to strike up a conversation when with a pet. People with pets are generally happier than those without.

I highly recommend that everyone get a pet. Your life will be greatly rewarded. But please follow housing and airline regulations for the comfort of all.

 

 

Stop Job Shaming

Remember Geoffrey Owens from the Cosby show? He played Elvin, the young doctor who married into the Cosby family. He was photographed while bagging groceries at Trader Joe’s and was caught in an unflattering shot. It represented a downward fall from celebrity for many people. He said he was initially humiliated at being demeaned for doing what he needed to do to make a living and support his family. He then received an onslaught of supportive remarks about the dignity of work.

The woman who took the photo later regretted it. She didn’t intend to job shame him but realized her error after the photo went viral. Owens accepted her apology. This story is an example of job snobbery and classism. All work is valuable and one field of work is not better or worse than another.

Blue-collar and service industry employees often feel judged. White collar professions do not necessarily make one satisfied or produce higher incomes. A Harris Poll found that 86% of blue collar workers said they are satisfied with their job. Blue collar workers are defined as jobs requiring manual labor in construction, manufacturing, transportation and warehousing, automotive services, maintenance, agriculture, forestry, fishing hunting or utilities. Interestingly, less than 1% of actors earn $50,000 or more per year, therefore you will find them in all sorts of careers to pay the bills at home.

There is a distinction between unskilled, semi-skilled and skilled workers. Semi-skilled labor does not require advanced training or specialized skills, but it does require more skills than an unskilled labor job. People who perform semi-skilled labor usually have more than a high-school diploma, but less than a college degree. Psychologist, Dolly Chugh, recommends that we stop using the term “unskilled” workers. Most of the jobs we call “unskilled” are actually highly skilled jobs that require manual dexterity, physical strength, endurance or patience. Negative assumptions are made of “unskilled” workers, contributing to a social hierarchy. We should also stop starting conversations with “What do you do?” and “Where do you work?” Someone’s livelihood does not define them. Being successful has nothing to do with what you do for a living. I’m reading that the US is becoming a “gig economy” in which people generate money from a number of sources. Think of Uber, Lyft, and work from home call centers which allow flexibility and added income.

So, why do we job shame? According to social identity theory, it is human nature to divide groups into “us” and “them.” Our social identity is based on group membership which gives us a sense of pride, self-esteem, and belonging. Sadly, the in-group will discriminate against the out-group to enhance their self-image. We see the group to which we belong as being different from the others, and members of the same group as being more similar than they really are.

Why do we take pleasure in another’s downfall? There’s actually a name for it. Schadenfreude. It is a bit of enjoyment at the misfortunes of others. It is a way to feel better about yourself. People with low self-esteem, or who feel threatened by others, tend to experience schadenfreude more often. People with higher self-esteem don’t need the misfortune of others to feel better.

Are you a job snob? If so, consider your motivation and examine your self-esteem. You might benefit from self-reflection.

Marijuana Addiction is a Real Thing

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No one dies of marijuana use. However, did you know that marijuana addiction is real? It is a disorder that includes physical withdrawal, cravings and psychological dependence similar to other substance addictions. Withdrawal symptoms can include chills, sweats, cravings, insomnia, loss of appetite, nausea, anxiety and irritability.

Have you heard of cannabinoid hyperemesis syndrome? I spoke with a young woman this week who told me she suffers from CHS. She saw her physician for nausea, vomiting, and severe abdominal pain. As he read the symptoms of CHS, she identified with every one of them. She has been unable to cease her marijuana use entirely despite many attempts to do so. She has no doubt that marijuana addiction is real. CHS occurs more frequently among people who smoke 20 or more days per month and multiple times per day.

About 9% of all marijuana users, and 17% of people who start smoking during adolescence, develop an addiction to it. The rate of addiction to marijuana is lower than addiction to other substances. Cocaine and alcohol rates of addiction are 15%, and 24% of people who use heroin become addicted. The process of dependence is slower for marijuana. It may take months or years before symptoms begin to affect a user’s life.

According to the marijuana industry and the federal government, total marijuana use has remained fairly constant over the past ten years despite increased availability.

Marijuana today is not the same as the pot that baby boomers used when they were teens. The potency is increased with genetically engineered plants and the use of concentrated products. Boomers’ pot had THC levels of 2-4%. Nowadays, the average potency is 20% THC and can exceed 30%. Marijuana concentrates and extracts now range from 40-80% THC.

Marijuana use among older Americans ages 55 to 64 is now slightly higher than their children or grandchildren ages 12 to 17. A study from New York University found that more than 20% of marijuana users over age 65 said their doctors recommended they try it for medical reasons. Medical marijuana can be quite different from black market pot found at parties. Eighteen to 25-year-old Americans are decreasing their use of heroin, but their use of methamphetamine and marijuana is up.

As in all addictions, you may suffer from dependency if you are unable to stop your use and if you experience negative consequences from your use. In the case of the young woman with CHS, she could not stop smoking pot in spite of her medical distress, marital and financial problems. Employment drug screens may also pose a threat to a stable life. Help is available.

Be careful.

Does Corporal Punishment Motivate Our Children?

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I never attended a Catholic school but I’ve heard many from my baby boomer friends. Many had been punished by being slapped in the face or hit with rulers when they were young. In fact, one friend told me of being hit in the hands by a nun with a ruler. He can’t recall why he received the punishment. However, he does recall his father taking him in hand back to the school, whereupon he threatened the teachers with a similar fate if they ever hit his son again. Corporal punishment occurs far less frequently now.

Is physical punishment in the school making a come back? Last week, a Christian school, the Georgia School for Innovation and the Classics, asked parents to give the school permission to paddle misbehaving children. Students from kindergarten through ninth grade were sent home with a permission form. The form is alleged to read “A students will be taken into an office behind closed doors. The student will place their hands on their knees or piece of furniture and will be struck on the buttocks with a paddle.” If a parent does not agree to paddling, the child will miss a week of school. One hundred parents returned the form and about one third of them granted their permission to paddle their child.

Let’s define our terms here. Corporal punishment is defined as the use of physical force with the intention of causing a child to experience pain but not injury for the purpose of correction or control of the child’s behavior. The American Academy of Pediatrics considers spanking with an open hand to be acceptable. It becomes unacceptable if it involves use of an object and extends beyond the buttocks, is conducted out of anger, or results in injury.

Corporal punishment was widely utilized in US schools during the 19th and 20th centuries as a way to motivate students to perform better academically and maintain objectively good standards of behavior. As of 2014, a student was hit in a US public school an average of once every 30 seconds. Studies suggest that boys, children of color, and children with disabilities are most likely to be victims of punishment.

The NIH (National Institutes of Health) published an article by Tomoda, et.al. “Reduced Prefrontal Cortical Gray Matter Volume in Young Adults Exposed to Harsh Corporal Punishments.” The bottom line is that frequent and harsh corporal punishment has negative impact to a child’s brain. Physical punishment actually alters the developing brain. They found children who were regularly spanked had less gray matter in certain areas of the brain that have been linked to negative outcomes such as depression, addiction and lower performance on IQ tests. The brain of a child who has been subject to regular spankings is less able to manage their emotions. And if they are less able to manage their emotions, they are more apt to receive harsh corporal punishment.

The American Academy of Pediatrics states “Corporal punishment may affect adversely a student’s self-image and school achievement and that it may contribute to disruptive and violent student behavior. Alternate methods of behavioral management have proved more effective than corporal punishment.” Dr. Robert Sege, a spokesperson for AAP and head of a Child Protection Program said “Corporal punishment is humiliating and is designed to be humiliating and that does not help a child develop their own sense of right and wrong and how they should behave.” Corporal punishment often teaches children that aggression solves problems.

If physical punishment is meant to increase motivation to perform better academically, it misses the mark. In fact, researchers have found a negative correlation between legality of corporal punishment and test scores. Students who are not exposed to school a corporal punishment exhibit better results on the ACT test compared to students in states that allow disciplinary corporal punishment in schools. Furthermore, there is no formal training of teachers in the appropriate use of physical restraints that takes into account the size, age, psychological profile of students, or those who may have existing trauma or mental health issues. The National Association of Secondary School Principals (NASSP) opposes the use of corporal punishment in schools. They cited adverse effects on students’ self-image and school achievement, increased truancy, drop out rates, violence and vandalism. There is also a potential for injury to students and increased legal liability to the schools.

According to Gershoff and Font in a social policy report, “in any other context, the act of an adult hitting another person with a board would be considered assault with a weapon and would be punishable under criminal law.” Why then, would we allow our children to be assaulted?

Just say no to paddling.

How Could I Have Been So Blind?

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As a psychotherapist who specializes in relationship issues, I often see people suffering after relationship breakdowns. They ask “why do I always pick the wrong person?” My standard response is that they are not psychic and they couldn’t have known what this person was like until they’ve spent a good deal of time together. Dating is a period of time to get to know someone before making a commitment. If a commitment is made during an early courtship phase, you may realize that a prince or princess is really a frog when the cloud of infatuation lifts and the rose-colored glasses are removed. Then the question becomes “why didn’t I see these red flags before?”

The truth is, love is somewhat blind for a number of reasons. First, the chemical rush of adrenalin and surge of hormones that come with infatuation causes us to perceive the other as an idealized mate. A hormone called Oxytocin is known as the “cuddle hormone” or the “love hormone,” because it is released when people snuggle up or bond socially. In men, as in women, oxytocin facilitates bonding. When we fall in love, we see them as smarter, prettier, or stronger than anyone else sees them. We are averse to seeing anything that threatens our warm bubble of love.

Second, it is human nature to ignore the obvious. Willful ignorance blinds us to valuable information, facts and behaviors that should alert us. Author, Margaret Heffernan, in her book Willful Blindness: Why We Ignore the Obvious at Our Peril, examines the cognitive mechanisms by which we choose, sometimes consciously but mostly not, to remain unseeing in situations where “we could know, and should know, but don’t know because it makes us feel better not to know.” She argues that the biggest threats and dangers we face are the ones we don’t see. Not because they’re secret or invisible, but because we’re willfully blind. We conveniently filter things that unsettle us.

Third, confirmation bias drives us to believe what we want to believe. We seek confirmation of what we already believe to be true. Confirmation bias is the tendency to search for, interpret, favor, and recall information in a way that confirms one’s preexisting beliefs or hypotheses. The effect is stronger for emotionally charged issues and for deeply entrenched beliefs.

Fourth, sometimes we are in the presence of someone who deliberately seeks to deceive and manipulate. We all like to think of ourselves as pretty sharp, but charlatans exist.

Are we doomed to repeatedly make the same mistakes? No. We can learn from experience.

  • Take your time. Don’t make a life long commitment in the first year and a half of dating.
  • Challenge your thinking. What red flags do you see?
  • Seek feedback from others. Others may see what you are blind to.
  • Love is an emotion, not a fact. Gather and verify information as you get to know someone new.
  • Don’t be too hard on yourself. It is human nature to seek and preserve love.

End of Life Decisions

I’m sad to hear news that Senator John McCain passed away at the age of 81. He was diagnosed with brain cancer last year. He spent the final months of his life out of the public eye, reflecting on the meaning of his life and accepting visitors. He planned his own funeral services. Senator McCain made a decision to discontinue medical treatment on August 24, 2018 and died the next day in his home surrounded by his family.

Senator McCain had a rich, satisfying and meaningful life. In a memoir published in May, Senator McCain wrote that he hated to leave the world, but had no complaints. “It’s been quite a ride. I’ve known great passions, seen amazing wonders, fought in a war, and helped make peace. I’ve lived very well and I’ve been deprived of all comforts. I’ve been as lonely as a person can be and I’ve enjoyed the company of heroes. I’ve suffered the deepest despair and experienced the highest exultation. I made a small place for myself in the story of America and the history of my times.” He bravely made a decision to stop life-sustaining treatment.

How does one come to a decision to discontinue medical treatment, knowing that it will hasten death?

The right to refuse end-of-life care was guaranteed to Americans in 1991 with the passage of the federal Patient Self-Determination Act (PSDA). It guaranteed that Americans could choose to refuse life-sustaining treatment at the end of life.

When you choose not to receive aggressive medical treatment, you are generally choosing what you believe will be a better quality of life, rather than a longer life that may be less pleasant. You have decided to stop futile, unnecessary or invasive treatment that may harm more than help.

You are still entitled to palliative care, which can be administered to people who don’t want to be kept alive. Palliative care focuses on relieving pain at the end of life but does not extend life. You continue to receive medical treatment that is aimed at comfort care, not cure, designed to treat pain and suffering.

When to stop aggressive cancer treatment is a very difficult decision. Many believe that cancer patients should not be subject to harsh and painful treatment. Yet, three out of four cancer patients in their last month of life, under the age of 65, received aggressive treatment and only a handful got comfort-based hospice care instead. Dr. Otis Brawley, the American Cancer Society’s chief medical officer said “there are hundreds, if not thousands, who undergo too much therapy and too much suffering for every one person that we have who ends up having a miracle.”

Are people who choose to stop medical treatment just giving up? No. You’re not giving up if you don’t do treatment. You’re still fighting for your life, in a different way. You’re fighting to have good, purposeful, meaningful days. It is a patient’s right to make these decisions for themselves.

It is a reality that some patients are unable to make this decision. They may lack sufficient knowledge regarding their condition. Or, their condition may involve cognitive impairment. Ideally, this decision is based upon information about the patient’s clinical state and circumstances, the available research evidence as well as patient’s values and preferences, including their preference regarding their role in decision making. Some people prefer that others make a decision for them.

It can be overwhelming to make healthcare decisions for someone who is dying and are unable to make their own decisions. Even when you have written documents, the documents may not cover every situation that arises. According to the National Institute of Aging (NIA), two approaches are useful. First, put yourself in their place and try to choose as they would choose. This is called “substituted judgment”. Second, is to decide what would be in the best interests of the dying person. This is known as “best interests”. If possible, combine both approaches.

NIA also recommends that if you are making decisions for someone at the end of life and are trying to use one of these approaches, it may be helpful to think about the following questions:

  • Has the dying person ever talked about what he or she would want at the end of life?
  • Has he or she expressed an opinion about how someone else was being treated?
  • What were his or her values in life? What gave meaning to life? Maybe it was being close to family—watching them grow and making memories together. Perhaps just being alive was the most important thing.

If you are struggling with end-of-life decisions, I strongly recommend you read Understanding Healthcare Decisions at the End of Life at nia.nih.gov. This guide includes questions to ask your doctor and medical staff, practical advice on issues you may face, family involvement, working with medical staff and more.