Want a good death? You need an Advance Directive
Most people agree there are two subjects that should be avoided at parties and other general gatherings: religion and politics.
But there’s a third one that might as well be included, because nobody likes talking about it, anyway … Death.
Many might agree with Woody Allen on the issue. He said, “I'm not afraid to die, I just don't want to be there when it happens.”
Nevertheless, it’s a part of life. As the saying goes, none of us is getting out of here alive.
What we do have some control over, however, is how we choose to make our exit. But it requires planning.
Surveys show that 7 out of 10 people would prefer to die peacefully at home, in their own bed, surrounded by family and friends. Ironically, 7 out of 10 die, instead, in a hospital, nursing home or other long-term care facility. And, as often as not, it’s anything but peaceful. Patients are hooked up to machines, surrounded by strangers who are trained to keep them alive at all costs, no matter how hopeless the cause.
The key to avoiding that unhappy end is by completing an Advance Directive, a set of directions to your family and caregivers about how you wish to be cared for should you no longer be able to make medical decisions for yourself.
This reporter, of an age when an A.D. should have been prepared already, sat in on a workshop recently to learn the ins and outs of Advance Directives. The three hour-plus session actually went by quickly, and ended with an opportunity to prepare one’s personal A.D.
Sponsored by the nonprofit organization End of Life Washington, the workshop was directed by two sisters, Karen Griffith and Judy McCay, who mixed light humor with cold facts as they helped participants come to grips with difficult questions about how we would like to die.
“Nobody has ever survived life,” Griffith said. “But we have a choice about whether it’s going to be easier or harder.
“Do you want a breathing tube down your throat? A feeding tube? Do you want to die in a hospital? Do you want punk rock blasting through loudspeakers or warm, classical music?”
The key, she said, is starting a conversation with your family about what you want. Not surprisingly, many don’t want to talk about it. But even the high and mighty have an expiration date. Winston Churchill, after suffering a stroke in 1953, began planning his funeral. He kept a folder tucked away in his desk detailing his wishes. It was labeled “Operation Hope Not.”
Griffith and McCay told stories of adult children who disagreed on how to care for an elderly parent, with some arguing for any and all medical procedures to keep the inevitable end at bay as long as possible, others insisting their loved one should simply be made comfortable while nature takes its course.
Had that parent drawn up an A.D. beforehand, the arguments would have been settled. However, when family members don’t want to talk about your death, Griffith advised you to try “the stealth approach.”
For instance, when talking about someone else’s death, you might say, “If I were in that situation, I would not want my life to be prolonged,” “I would not want to be kept on life support,” or “I would never want my family to be torn apart making difficult decisions.”
As often as not, doctors aren’t much help, either, unless you take the initiative. “There’s a conspiracy of silence around dying,” Griffith said. “Doctors don’t want to bring it up.”
And just telling your family or doctor about your wishes isn’t good enough. You’ve got to put it in writing. Memory is a funny thing; people differ on the details. And doctors are trained to save lives, not to accept death. If you don’t put in writing how you want your final days to go, you could be subjecting yourself to futile, painful treatments that may extend your life, but it won’t be pleasant.
When talking to your doctor, you might start the conversation this way: “I’ve had a good life. I’m ready to accept death when it comes. It’s important that you speak honestly and openly about my prognosis.”
Other openers might include:
“What would you do if you were in my shoes?”
“If your mother was diagnosed with what I have, what would you tell her to do?”
If you’re among the handful who want to fight death to the bitter end, then there’s nothing you need to do at all; that’s the model in today’s medical world.
But if you want to die with a smile on your face, then you should do an Advance Directive.
McCay said most people put it off. But really, anyone over age 18 should have one.
Why? Stuff happens. Remember Terri Schiavo? In 1990, she had a heart attack at age 28, suffered massive brain damage and was left comatose. Eight years later, her husband petitioned to have her feeding tube removed, arguing she wouldn’t have wanted to live that way.
Her parents disagreed. Court battles ensued. Politicians weighed in. And a very private, painful family issue exploded into a very public fight about a person’s right to die. An A.D. would have spared her and her family from what became landmark decisions on right-to-die and right-of-privacy cases.
An Advance Directive is a legal document that states your wishes about medical care when you can’t speak for yourself. Its purpose is to ensure a peaceful, humane death on your own terms.
End of Life Washington can help you get it done. Griffith and McCay, as well as other volunteers, regularly hold workshops around the state, explaining the various options you have and decisions you’ll need to make.
Besides Advance Directives, they also can provide Alzheimer’s and Dementia Advance Directives, Physician Orders for Life-Sustaining Treatment (POLST) forms, and information about Washington’s Death with Dignity Act.
Information on upcoming workshops, health fairs and other events, and free downloadable planning documents are available on their website at www.endoflifewa.org.
Why wait? Despite Woody Allen’s wish, when death comes, you will be there.