Dear Older Self,
I encourage you to pay attention to end-of-life medical planning.
You have benefited more than once from elderly family members and friends who did this basic planning. When it came time for someone else to step in and make decisions on their behalf their advance preparations made it possible for you to follow their desires for end of life care. When a family member languished in bed after a stroke, you were able to put him on hospice care, knowing he would not want further treatment. When another family member with dementia, who was on hospice care for sometime, stopped eating and drinking, you knew to not to intervene with IV’s or tube feedings. The advance directives these loved ones had created provided a great deal of comfort for you and for other family members as you made what otherwise might have been very difficult decisions.
In contrast to these experiences, you have witnessed the pain and chaos that can ensue in families where these preparations had not been made. You have seen family members accuse each other of wanting to kill their elderly loved ones, while others were being accused of adding to their loved one’s suffering. Most of these terrible conflicts could have been avoided if an advanced directive was in place and had been discussed with each family member.
In spite of the help this kind of preparation can be at the end of life, many people neglect to do this work. Sometimes we neglect important matters because they generate anxiety. Our own death is one of the clearest examples of this problem. We do not like to talk about death and dying in our culture. Even though death is guaranteed, we tend to push thoughts of it away. As we do this, we also neglect important planning that needs to be done for the final stage of our life.
We may also neglect this important planning because we have always been completely responsible for deciding if and when to obtain health care services. The thought that other people may have to make important decisions for us may be more than we want to think about.
One way for us to have some voice in our heath care at the end of our lives is to take a few simple and inexpensive steps to make our desires known about the care we want to receive and the care we do not want to receive at the end of our lives.
It is true, dear older self, that as long as you stay alert, you will be able to communicate what you want and don’t want. But you may not be alert or able to do this in your final days. It is always possible that family members or caregivers may have conflicting ideas about the kind of care you should receive. One person may want everything possible done to keep you alive. Another person may resist the idea of aggressive medical intervention, except whatever might be needed to keep you comfortable. Only by making your wishes clear in advance will you be able to help your family and care givers make decisions which are consistent with your wishes.
Letting go of a loved one is very painful. Feeling responsible for complicated end-of-life decisions can sometimes be more than a family can handle. Making your wishes clear in an advanced directive that you share with your medical team, your support people, and all your family members can make it possible for you and those you love to spend your last days together in relative peace. It can be a time for saying “thank you” and “good-bye” rather than a time full of difficult decisions.
There are three documents that you either need to create or need to revisit. They are collectively referred to as “advance directives.” The three documents are a living will, a medical power of attorney and a letter of instruction.
A living will lets your family, your caretakers and medical professionals know what treatments you want to receive and what treatments you want to refuse under what conditions. It will only be used if you are unable to communicate your wishes at a time when decisions about your care need to be made.
A health care power of attorney names a person who you trust to make health care decisions for you if you are unable to make decisions for yourself. You will want to have a conversation with this person to make sure that they are willing to take on this responsibility should the time come when it is necessary. Even if this person is not making your decisions for you because you are alert and able to do this for yourself, this document will allow them to more directly advocate for you with your medical team acting like a mediator when you are too weak to do this for yourself.
A letter of instruction clarifies any special requests you may have such as plans for your funeral, people you want to have contacted, phone numbers or contact information for these people.
The living will and the health care power of attorney are legal documents but you don’t need a lawyer to prepare them for you. You can search online for a copy of your state’s version of a living will or power of attorney for health care. The letter of instruction is not a legal document and it can include whatever you want to include by way of last wishes, arrangements and contact names and numbers.
All three of these documents need to be in writing and need to be signed by you. Your closest family members and your primary physician all need to have copies of all but the letter of instruction. Sometimes it is a good idea to post a copy of the health care power of attorney form in a prominent place in your home (on the wall in your bedroom, for example) This will alert any emergency response team that comes to your home about the decisions you have made.
It is a good idea to discuss these directives with your closest family members and support people so you can answer questions and concerns. As part of this same discussion it would be a good idea to share other health information. For example, it would be a good idea to share a copy of your list of medications. Keep a copy in your own wallet in case you find yourself in an emergency room and they ask for this list. And make sure the person who has durable power of attorney has a copy as well.
In addition to creating these documents and sharing them with your family it would be wise to research the hospice providers in your area that are covered by your health insurance plan and to share this information with your family as well. You will want to discuss the value of hospice care as a way of providing support and comfort as you near the end of your life. Hospice services can help you avoid the distress and expense of emergency room visits and admissions to intensive care units.
Dear older self, I know you want your death and dying to be as peaceful for you and for your loved ones as possible. Taking time to take these simple steps can make a significant difference.
This meditation is taken from Notes to Our Older Selves: Suggestions for Aging With Grace by Juanita Ryan and Mary Rae. You can get a copy at Amazon.com