Control the End of Your Life
In these letters, I spend most of my effort helping you be the healthiest version of yourself possible.
But there is a slightly different issue I want to deal with today. It’s a crucial one—one that each of us will face at some point. But one that most people avoid at all costs.
I’m talking about the choices surrounding the end of your life. And why—if you haven’t already made your wishes known—you owe it to yourself, and your family, to create an advanced directive.
If you don’t have an advanced directive, you’re playing with fire
No one likes to think about their last days. But that won’t stop them from, someday, coming.
Not to mention, it only takes one errant car to put you in a precarious state today.
And, when you’re suffering the effects of an accident or illness, things can get chaotic.
You may or may not be conscious, or able to make your wishes known. You may or may not have discussed different scenarios with your family. Your family may or may not even know who’s supposed to make your health decisions in the first place.
This may not feel like a problem. These things will work themselves out, you assume.
Not so fast.
Without instructions about how you want to be cared for, family members will often fight—sometimes in court. Doctors will have no cover to exercise judgment, so you’re likely to receive the most aggressive treatment available—regardless of cost or the pain you may go through, even when there’s no hope of recovery.
Instead of spending time in your preferred locale—be it home, hospice, or a beach in Rio—you’ll be locked up in a hospital room, for thousands of dollars a day.
There could easily be hundreds of choices made at the end of your life. And if you haven’t created an advanced directive, odds are, you won’t like the way a number of them go.
Alarmingly, almost three quarters of American adults don’t have an advanced directive. That makes for a lot of difficult decisions during times of stress.
You owe it to yourself, and your family, to plan now, and make the end of your life as painless as possible.
Power of attorney for health care
The first thing you should do is assign someone to be your healthcare proxy.
If you have had end-of-life discussions with this person already, this simple document can solve just about every problem.
Lacking a power of attorney, most states will ask the spouse first, then adult children, then parents.
But that isn’t necessarily as clear-cut as you think.
Have you been married more than once? Is it your current spouse? What if you were with your previous spouse for 40 years, and your current one for three months?
And if it goes to your children, what if brother and sister disagree? Likewise, what if the siblings gang up on a new step parent?
You see how easily this can get confusing. Add the stress of seeing a loved one in pain, and the potential for spats is enormous.
Take away all that risk by simply naming someone your healthcare proxy. That way, the doctors—or courts—don’t have to play referee, and everyone can concentrate on what is best for you.
A living will
The second part of an advanced directive is your living will.
This specifies how you’d like to be cared for.
Some people worry that a living will gives doctors permission to “put your out of your misery.” Not in the least.
A living will simply says how you’d like to be cared for—no more, no less.
You can give a standing DNR—Do Not Resuscitate order—if you want. If you don’t want to hold on in a hospital, you can get it over all at once.
Or you can instruct a doctor to give you everything they’ve got, in the hopes that what ails you now might be curable before you go.
And there’s plenty of gray area in between that you can happily specify. Life-saving measures, unless it becomes a financial burden—giving your family the gift of a guilt-free decision. Yes to feeding tubes, no to CPR—knowing most doctors with advanced directives don’t want CPR performed on them, since it’s always painful and rarely effective.
Pull the plug when there is zero chance you’ll wake up. Or stay plugged in long enough for everyone to say goodbye—and then end heroic measures.
You can even make room requests—like getting a view, or putting on your favorite sports team or jazz program if you can hear, but not speak.
The important thing is, with a living will, you can make all these crucial decisions before they come up, in the calm state of health. Instead of laying them at the feet of your family, or your doctors, during a time of intense stress and difficult options.
It’s no one’s favorite subject. But a little time spent thinking about the end of your life now, the more likely it will be the pleasant, peaceful time that you want it to be.
And it doesn’t have to be hard. There are plenty of free options out there, through sites like POLST.org or My Directives.
You just answer a few questions—taking perhaps half an hour—and you’re done.
Then you print out your directives, and give a copy to your primary care physician, or any doctor that you’ll work with.
And, at the very least, assign someone you trust as your healthcare proxy. If they know you, they’ll do what you would want anyway.
And that’s all that really matters. That, and making a difficult situation easier for the ones you love.
- Jaya K. Rao et al, Completion of Advanced Directives Among U.S. Consumers, American Journal of Preventive Medicine, Jan 2014, 46:1:65-70
Last Updated: August 16, 2018
Originally Published: July 22, 2016