Medical care today is very different than it was for our parents and grandparents. There are technological developments that can save and prolong lives that our ancestors never imagined. Most of these brilliant inventions and interventions can be considered almost miraculous, and we are thrilled they exist: resuscitating a child after a near drowning; bringing a young heart-attack victim back to life who still has a family to raise; changing the course of injuries when an automobile accident seems to have abruptly cut a life short; or prolonging a life, using dialysis, while the patient is waiting for a transplant or for an infected kidney to heal.
However, these accomplishments can sometimes be less than a miracle: when a 90-year-old's heart stops beating on the operating table and the attempt is made to bring her back to life; or, when a child with advanced leukemia is offered a third, painful bone marrow transplant when he has already suffered invasive treatments and death is likely to come sooner than later, with or without the treatment.
Such situations led to the creation of certain legal documents, generically known as advance directives. People who experienced prolonged dying processes or unasked-for resuscitations requested by family members began to think of ways to prevent such occurrences for themselves.
The earliest advance directives document was called a Living Will. People were encouraged to describe in writing their desires for the end of their life. These wishes included what kinds of treatments they wanted, or did not want, depending on certain circumstances.
As time passed, it became clear that all situations could not be imagined ahead of time. A second document, called the Durable Power of Attorney for Health Care, also known as a Medical Power of Attorney, was created. In it, a person, called an agent or proxy, is appointed to speak for the individual if he is unable to communicate on his own behalf. For obvious reasons, this person would necessarily be someone deeply trusted. The document also includes the individuals stated wishes regarding end-of-life care, including whether he wishes intervention.
A third document, called a DNR (Do Not Resuscitate), is a short statement that the patient does not want to be resuscitated. Most hospitals and nursing homes now ask patients to fill out a DNR upon admission, as medical emergencies do not usually allow time to discuss these issues with family members, or agent, as the crisis unfolds.
Will creating advance directives solve all of the problems that modern medical technology has created? No.
Should you fill them out anyway? Absolutely yes!
The existence of these documents not only enables you to express your wishes regarding end-of-life care, but also may save your loved ones hurtful discussions about the issues involved. Do they truly know how you feel about life and what you interventions you wish to submit yourself to? Do you, for that matter? The act of making choices about your end-of-life care has the potential of illuminating how you really feel. Considering the quality of life you desire, the kinds of interventions you desire or not, the person you choose to speak for you, and the type of disposal you want for your body, are profound topics. They can guide you to deep places within your own soul, as well as with the relationships to the people you love.
Facing this task may also cause you to make important life choices, sooner than later, about work, travel, completing unfinished business, financial affairs and more. In fact, one of the most useful, and pleasant, ways of going about creating your advance directives is to have a gathering to work on filling in the blanks together with family members or a close circle of friends. Intriguing conversations can ensue, often interspersed with laughter. Finish up with a potluck!
Advance directives will have the greatest value if first, you discuss them with the important people in your life, and second, they know where to find the documents if you cannot speak for yourself.
Some important points:
· Advance directives can be obtained via the Internet, free or for a small fee, from your doctor, hospital, or nursing home. (Visit www.agingwithdignity.org which provides the user-friendly Five Wishes document.)
· The documents are sometimes state-specific, so pay attention when you are traveling.
· Advance directives can be of value to anyone who is 18 or older. It is not only older people who have accidents or suffer from serious illnesses.
· Make sure you discuss your choice of agent with that person before you write his/her name in your document. It is a big responsibility and not to be taken lightly; some people may not be willing, or able, to take on the task.
· Often, the most-likely person is not the best person to choose. A sibling, parent, or child may not be able to follow through with your decisions, especially if he/she doesn't know your true wishes. Also, if that relative lives at a distance geographically, it may be better to choose a friend who is nearby.
· Remember that most people do not lose consciousness before they die. These documents are only needed when a person is unconscious or has severe dementia. But, it is wise to create these documents now, before a crisis occurs, before your mind goes, and while you can still hear.
· Be sure to inform, and give copies to, your loved ones, doctor, attorney, spiritual leader, or next-door neighbor. A neighbor may be more likely to witness a crisis and be available to help than a trusted friend or family member who lives far away.
· The documents can always be changed and updated. In fact, it is good practice to review them annually. If changes are made, redistribute the updated documents.
· Enjoy the conversations you have with your loved ones concerning these advance directives. You never know: they may be the last opportunities you will have to speak from your heart, share your spiritual and philosophical beliefs and thoughts, forgive, and express your feelings to them.
