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Life and Death Instructions Life and Death Instructions |
Life and Death Instructions
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Another means of achieving the freedom to focus on the present is to communicate your desires about life and death. Whether you want to be resuscitated if you have no chance of regaining a reasonable quality of life, and what you want done with your remains. In the former instance, you need only to sign a durable power of attorney with specific instructions to your medical team. In the latter case, you will want to leave written instructions for your family and friends as to whether you wish to be cremated and how you want your ashes or remains be handled; whether you want a funeral service; and so on. If you don't have a will for the disposition of your estate, this is a good time to get that out of the way as well. (You can always change it later.) The act of leaving instructions on these matters is a gift to those you love.
Planning for the End of Life
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With all of the changes and advances in medicine, there is more talk about issues concerning life and death. We all know that we can't get out of this world alive. But at the same time, we Americans avoid discussions about life and death.
Because major advances in medical care can now prolong life, such discussions are becoming vital to improving patient care. One has to assess the medical rationale for performing procedures and interventions, such as cardiopulmonary resuscitation (CPR) or artificial breathing (through use of a ventilator). The patient's quality of life and his or her chances for recovery have to be considered in making such life-and-death decisions.
Physicians often go to heroic lengths to keep terminal patients alive--often against the patient's wishes. Most people assume that when the time arrives for making life-and-death decisions, their physicians and family will make the choices for them. But the family's and physician's views and decisions may not necessarily agree with the patient's. We should all assess our own values regarding quality of life and make decisions on how we wish to live and the type of care we desire at the end of our life. This can be accomplished through Advance Directives and/or through filling out other forms that document your wishes about your future. Such documents give us some measure of control over our medical treatment when death threatens our survival. Through them, we can provide clear instructions if we are unable to state our wishes because a serious medical condition impairs our ability to communicate. With such documents we can also ease the burden of responsibility left to our survivors by putting our business, legal and personal affairs in order. In these ways, we can help by making decisions about our death ahead of time and so make things easier for our loved ones.
Although the Patient Self-Determination Act was passed in 1990, less than 10 to 15 percent of our population has prepared Advance Directives, which are desirable and valuable to patients, families and physicians. Advance Directives are legal documents such as Durable Power of Attorney for Health Care, the California Natural Death Act declaration, and the Prehospital Do Not Resuscitate (DNR) form. Why do so few of us complete these important forms? In part, it's a result of the fact that many physicians do not bring up the subject, because they don't want to increase the fear of death in their patients; and in part, it's because the public does not wish to make the kinds of cumbersome decisions required in completing an Advance Directive.
This module contains the advice of a group of experts who have contributed their thoughts on why and how each person should organize the final details concerning his or her possible illness and death. It will help guide you through the maze of issues that are important to consider and offer suggestions about how decisions can be made before or during a hospitalization. It will also offer a way in which you can help your family and significant others deal with the details if your illness becomes terminal.
These topics may by their very nature be difficult issues for you. However, they represent important factors about how you may want to be treated and how you want your wishes to be carried out if you cannot make decisions for yourself. Some of the necessary documents that will help ensure that your health care wishes are recognized and included.
Preparing for Your Decisions
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Death is a part of life. We all know that we must die sometime: we just don't know when. Despite this reality, we often think of death as something that happens to other people. Most of us have a difficult time accepting our own mortality, and won't even think about it until a crisis forces us to do so. Even then, we may fight and bargain to gain more time.
Accepting death is an issue for doctors as well as for patients. Because our society views death as a failure or point of giving up, many doctors fight to preserve life at almost any cost. The consequences of lost time or money, as well as the emotional strife of both patients and family may not be fully considered when assessing whether to keep a patient alive. This may be confusing and frustrating to a patient who wishes to die a dignified and peaceful death but cannot express it. Advance Directives help to avoid these situations in which the medical team's and patient's wishes conflict.
Factors that May Influence your Decision
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How we live our life and how we plan for our death are personal choices. Society also influences us as we observe the attitudes, ceremonies and rituals that surround death and dying in our culture. For guidance in these important decisions, many of us seek religious or spiritual advice.
Since the late 1950s, advances in medical technology and medical practice have changed how patients, lawmakers, physicians, ethicists and society in general think about and define life, death and dying. We may have watched how others have reacted to the death of a loved one. Many of these changes have resulted in serious ethical dilemmas for the medical profession, causing doctors to reassess their role in caring for patients. Patients and their loved ones, faced with the possibility of prolonged suffering and delayed death, have been asking for the power to make their own decisions and to die naturally with dignity. Each person should know about his or her choices for discontinuing aggressive treatment with respect to the newer ethical and professional dilemmas.
Euthanasia or Physician-Assisted Suicide
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To hasten a person's death by active euthanasia is inconsistent with the hospice philosophy of providing quality care at the end of life; but attaining effective pain control may in some cases hasten death. The hospice will focus on helping patients differentiate between giving up and accepting death as a natural progression in life.
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- by Ernest H. Rosenbaum, MD & Isadora R. Rosenbaum, MA
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