Medical planning form prompts self-reflection
By Prue Salasky
Anyone who has seen the film “Amour,” a harrowing depiction of end-of-life issues, shouldn’t need to be told that they need an advance medical directive. Still, it wasn’t until I started work on the series that ran earlier this week that it finally clicked that I, too, should have a document stating my desired medical treatment in the event I become incapacitated.
The “living will” or “medical power of attorney” papers aren’t just for the frail or infirm. They’re guides in the event of any unexpected medical emergency or accident, and also a way to track your thoughts about life and life-end treatment. And a way to monitor changes in those over time. And a last-ditch way to maintain control over your life.
It’s so easy to put off. To rationalize and to procrastinate. Death or disability isn’t something we like to think about. It’s a chore to put together a document and it’s easy to dismiss it with banter. “Just give me the hemlock,” are words we’ve exchanged often in my household when discussing various conditions that would seem to make life unbearable.
So, it’s easy to think that your closest loved ones, your spouse and your children, family and friends, know that you wouldn’t want to be hooked up to machines or to lie drooling and immobile after a stroke (a genetic predisposition that runs strongly in my family). But, the decisions aren’t so clear-cut and the nuances endless.
Still, I managed to detach myself from the whole concept of advance planning, feeling that it didn’t apply to me, until I talked to David Cochran, director of Sentara’s Center for Medical Ethics. All he said, quite simply and directly, was, “Do you have one?”
I started thinking about it. I’d looked at the forms before. I’d written articles urging their importance, but I’d never taken the necessary steps. (At least, so I thought.) The form itself is readily available on the Internet and when I mentioned my intent, my husband, an attorney, said, “I have forms at the office.” He also reminded me that I had actually filled one out long ago and it was in the bank vault.
I had no recollection of it — I could rustle up a glimmer of a memory of having witnesses sign papers (but was that my will?), but it was definitely decades ago before my children were adults and patently useless being neither current, known to extended family, or readily at hand.
Also, I hadn’t given it the thought that should go into it. For more than a week, I conducted an internal conversation with myself about sickness and death. I took a trip down memory lane, recalling the deaths of my parents and in-laws. My mother-in-law died at 65 from cancer; with the expert care of her husband, a physician, she was able to spend her final months at home. At relatively advanced ages, both my father and father-in-law died in hospital after recurrent illnesses; both were ready to let go sooner.
I can still hear the whir of the morphine drip that kept my mother’s pain at bay as she “waited” for all her children to gather from around the world. Within hours, she slipped away, in her bed at home, surrounded by family.
I remembered the death of my aunt a few years earlier in an intensive care unit. My parents were not allowed to visit her bedside but only to observe her through glass. “She looked so scared,” they repeated over and over, shaken to the core.
I remembered visiting a friend’s father in a nursing home, unable to speak and struggling to breathe with a trach tube that required constant suctioning. He had lived there for years.
I resolved to make my wish to end my days at home, if at all possible, well known.
The next thing I had to consider, in many ways the most important element, according to the experts, was the designation of an agent to express my wishes in the event I become incapacitated — after all, that’s when an advance directive kicks in. I thought about each of my children even though their geographical distance for the most part makes them ineligible. Still, it was an interesting exercise to consider how they might react to the responsibility and also how I might best broach the topic with each.
As suggested by the pros, I considered friends and extended family, but I quickly excluded each on different grounds and came back to my husband as the best choice for several reasons. Not only have I discussed the issues more with him than any other, but I also know he has the emotional fortitude to do what I would want. I observed him tending to his mother in her final hours, his solicitousness with his father as his health failed, and his ability to separate his grief from the task at hand.
You can pick up an advance directive form at the doctor’s office, hospital, lawyer’s office, or just print one off the Internet. It’s in the Virginia Code § 54.1-2984.
Riverside Health System has one half the length — three pages — that includes the appointment and powers of an agent; general health care instructions; end-of-life health care instructions; and organ or tissue donation. Sentara’s is similar, but organized in different order, and includes a form to register it with the U.S. Living Will Registry that makes it easily accessible. The web site Virginiaadvancedirectives.org has several versions, including one for directing mental health treatment. It also answers every question you might have. All these options are offered free.
It’s going to take me a little more time to complete as I mull all the possibilities, but I’m well on my way. Then I’ll discuss the details with those who should know.
To find the series, go to www.dailypress.com/health and enter ‘advance directives’ in search.
(Published June 15, 2013)
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