Well it looks like the scaremongers have succeeded in removing provisions for voluntary end-of-life counseling from the pending health care reform legislation. (Although their broader goal: killing health care reform, remains elusive.) That means you may be on your own to figure things out. Luckily the Wall Street Journal has a good piece today on Advance Directives (Preparing for the Final Hours).
“Everybody knows they’re going to die, but it’s really scary to think about how,” says Audrey Seeley, a registered nurse in the stroke unit at Inova Hospital in Falls Church, Va., who sees many patients who are suddenly seriously incapacitated. “A lot of people say, ‘If I get to that point, I don’t care what happens to me.’ But your family does.”
Indeed, advance directives are as much for the living as for the dying. Without specific instructions, family members may have to decide whether you would want to be kept alive artificially, what level of disability you’d be willing to live with and how to let you die if you had no hope of recovery.
Advance directives are a tricky business. No one knows what sort of end-of-life situation they’ll find themselves in or whether their wishes will be taken into account at all. And end-of-life isn’t always so easy to define except in retrospect. When someone’s told they have six months to live it’s often off the mark.
It seems straightforward to say –as the nurse quoted above does– that, “If I get to that point, I don’t care what happens to me.” But I don’t even think people can say that with confidence. When you’re healthy and strong, it seems like it would be much better to die than to sit around partially-demented, incontinent and in pain. But when you actually get to that point, you may look at things differently: that extra few months with your family –or even alone in your thoughts– may be worth the trouble. By that time you may not be able to express yourself so well.
Some people set out general principles. Others take the path of leaving everything up to a loved one. Other people leave strict instructions that they want every measure taken. Sometimes that’s for religious reasons and sometimes it’s because they don’t trust their relatives or doctors.August 18, 2009