Want a good death? Prepare now
Note: Following an article on Advance Directives published in last month’s Prime Living section, Dr. Richard Stuart contacted us about other opportunities for people to plan their Advance Directives, also known as Living Wills, which are legal documents that let people state their wishes for end-of-life medical care.
Dr. Stuart, a psychologist and professor emeritus in the University of Washington’s Department of Psychiatry, has created a website called 6-Steps that guides people who are ready to make some of life’s most challenging decisions. He has helped more than 700 people create their Advance Directives, ensuring their dying wishes will be followed.
When his beloved uncle became seriously ill in 1980, Richard Stuart witnessed first-hand the tragic end a person can suffer if he’s unable to express his wishes before it’s too late.
Advance Directives, or Living Wills, were not yet available, and Dr. Stuart’s uncle was afraid he would end up a burden on his family.
“He really wanted to die,” Stuart said. “But in 1980, there was no way his issues could be expressed.
“He didn’t want his wife to remember him as an incontinent, blathering baby.”
But that, essentially, is what happened. “He ended up living in a nursing home for four years in absolute agony,” Stuart said.
Advocates for a better way, including Dr. Stuart, former Rep. Jim McDermott and others, began pushing for changes that today offer people an opportunity to decide in advance how they want to be cared for should some future illness or accident prevent them from making life-and-death decisions later.
Although surveys show some 70 percent of people want to die at home, 70 percent actually end up dying in a hospital, nursing home or other care facility because they didn’t plan ahead.
“I feel compelled to help people understand the nature of the decisions they make,” Stuart said. “People need to have facts at their disposal.”
He said surveys show 26 percent of people want all possible medical treatments, even if it’s futile. Some are strongly religious, and have faith that God will intervene; others simply aren’t ready to die.
Doctors, of course, are trained to do everything they can to keep a person alive. They look at death as failure.
And, as more hospitals and medical centers are taken over by business executives whose eyes are on the bottom line rather than patient care, there’s even more reason to give people needless tests, treatments and other services.
“End-of-life care is revenue generating,” Stuart said. “There’s a bias toward doing more, rather than less.”
In surveys, 53 percent of doctors admit they prescribe unneeded tests.
“Unnecessary is one thing,” Dr. Stuart said. “Futile is something else. Care we don’t want costs a fortune.”
Without a Living Will in place, many people are making important decisions for loved ones in stressful situations without knowing the facts.
For instance, should you need a feeding tube because you’re no longer able to eat, do you know it will be painful? That you won’t be able to talk? That your throat will be constantly dry and itchy? That you may be restrained because you’ll try to pull the tube out?
How about CPR? A life-saving procedure that looks easy on TV, it’s actually quite violent, Stuart said. Compressions are supposed to be about 2 inches deep, forceful enough that ribs are often broken; the splintered bone, in turn sometimes pierces a lung.
And unless CPR is begun within 4-6 minutes, brain damage is likely. In some communities, first responders don’t even arrive within that time frame.
“It’s important to know the facts, rather than the fantasy,” Stuart said.
Thanks to people like Dr. Stuart, medical centers like Swedish Edmonds that regularly offer workshops on Advance Directives, and other providers offering seminars, people have more opportunities than ever to get those facts.
One such opportunity is coming on Saturday, May 20, at Swedish Edmonds. To sign up, call 425-640-4460 or email advancecareplanning-EDM@swedish.org.
Also, while it’s best to work with a facilitator when drawing up your Advance Directive, you can learn more about the process or try it on your own at www.6stepslivingwill.org. Everything is free.