EP52: Wishes At End Of Life

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. EP52: Wishes At End Of Life - Summary Dr. Warwick Bishop is a practicing cardiologist and author dedicated to educating patients about heart health and improving their care. In this episode, he addresses end-of-life wishes and Medical Orders for Life Sustaining Treatment (MOLST) forms, exploring both their benefits and limitations in documenting patient preferences during critical illness. Drawing on nearly 30 years of experience in end-of-life care decisions, Dr. Bishop advocates for thoughtful, ongoing conversations rather than relying solely on standardized forms. Key Takeaways: MOLST forms provide valuable documentation of patient and family wishes, allowing specific preferences like refusing blood products or resuscitation to be clearly recorded in medical notes. Forms are inherently "brittle" and cannot easily capture the nuances and complexities of individual patient situations or reflect moment-to-moment changes in medical conditions. The presence of a MOLST form noting "no resuscitation" can create a subconscious perception among ward staff that leads to a step-down in overall care quality for patients. Timing matters critically—filling out MOLST forms during a patient's first hours in the hospital creates uncomfortable conversations and puts pressure on junior doctors, patients, and families who are unprepared. End-of-life conversations require deep understanding built over time; Dr. Bishop is only comfortable having these discussions with patients he has known for months or years. Most patients prioritize living with dignity and functionality, wanting to avoid becoming "a vegetable" or entirely dependent on machines or other people. Decision-making about end-of-life care should be flexible and adaptive, made as challenges arise rather than fixed in advance, because medical situations can change unpredictably. Dr. Bishop recommends discussing end-of-life preferences with family broadly rather than waiting for a crisis, allowing people to express their values before facing critical illness.