Advance Planning: Making Tough End of Life Decisions

Several months ago, I received a copy of a very thought-provoking book, The Best Way to Say Goodbye: A Legal Peaceful Choice at the End of Life, by Stanley A. Terman, PhD, MD. It is an exhaustive resource on a method that can be used to end one’s life through the voluntary refusal of food and fluids.

It is difficult for most people to discuss end of life. It only gets more difficult when you consider when and under what circumstances you might wish to end your own life, and when you consider the personal, political, religious and moral aspects of doing so. Terman addresses all of these complicated aspects, and reminds us that people have chosen to die in this fashion for many, many years. A person’s right to die is as old as humankind and each age and culture throughout history has their response to this intention and the carrying out of this act.

Perhaps the best way to approach the discussion about end of life is by considering some of the most important questions. What do you want in your life as you get older? Under what circumstances do you wish to remain alive? These are tough questions, but they need to be answered. Don’t forget these key considerations:

• Speak with the people who will make decisions for you, and those for whom you will make decisions. Ask them what they would want done, and what they would not. You may be surprised at what you hear.
• What is the extent of treatment that you feel is acceptable? When do you think it is time to end treatment? When would you want to extend treatment? Regina, my mother-in-law of blessed memory, always said, “I don’t want to be a vegetable.” She let us know that when she stopped being herself, she no longer wanted to be alive.
• How does your religious and/or ethical path guide you in your decisions? A client of mine with Alzheimer’s was treated rigorously throughout the course of his disease, given antibiotics each time there was an infection, had a stomach tube and lived as long as his physicians could keep him alive because that was within the dictates of his religious belief.
• Consider who will make decisions for you. If you disagree with a relative or child about extent of treatment, consider having others take on the role of health proxy.
• Is your physician amenable to your wishes? The New York Times recently wrote about a practice called “slow medicine, which encourages physicians to put on the brakes when considering care that may have high risks and limited rewards for the elderly, and it educates patients and families how to push back against emergency room trips and hospitalizations designed for those with treatable illnesses, not the inevitable erosion of advanced age.” Geriatricians are traditionally in synch with their patients, and more comfortable with limiting treatment than doctors who work with patients of all ages.

After you have discussed your wishes with a close friend or family member, you can meet with a geriatric health care professional such as a physician, nurse or social worker to learn how to most effectively record your wishes. A health care proxy is the essential tool to record these wishes and legally designate people (proxies) to make medical decisions on your behalf if you are unable to do so at some point in the future.

For more information on Dr. Terman’s work, visit www.caringadvocates.org

Be well,

Arleen

Posted in Advanced Planning, Communicating with Loved Ones, Dying with Dignity, End-of-Life, Hospice & Palliative Care, Essential Documents, Geriatric Care Management, Living Wills & Advanced Directives, Living Wills & Advanced Directives