It’s probably the hardest conversation you can have with someone you love. If something should happen, and you are unable to make the decision for yourself, under what conditions do you want to use every means at the doctor’s disposal to save your life, and under what conditions would you prefer to just be made comfortable and let nature take its course?
No one wants to talk about dying, yet it will come to us all. Failing to have this conversation while you are healthy will force your loved ones to make the most difficult decision, literally of life and death, while trying to cope emotionally with the traumatic event that has forced this decision upon them.
My wife Jane and I had the conversation, many times. We were fortunate – we had the kind of marriage where no topic was too delicate, or taboo, to talk about between us: politics, philosophy, religion, even death.
When Jane’s mom had a heart attack, leaving her bedridden, we talked about the virtues and pitfalls of carrying on with diminished physical capacity. When my mother descended into dementia, we talked about the hopelessness of living out your life unaware of who you were while you waited for your physical body to give out. And when Jane’s oldest daughter Pam died of cancer after a heroic fight, we talked about the value of efforts to prolong your life, and the tradeoff between longer life and quality of life.
What lessons we ultimately drew from these experiences, and the personal decisions we made, are less important that the fact that we had those discussions. A frank dialogue ensured that there would be no ambiguity regarding our personal wishes, if that awful day should ever arise.
The next step was to document those wishes in a legally binding way. In New York State, that meant completing a health care proxy, available on the web. No lawyer is required; it simply needs to be witnessed by two people. This form specifies who will make medical decisions for you, in the event you are unable to make them yourself. It is imperative that you designate someone who not only understands your wishes, but is committed to executing your wishes if the time comes.
One additional step can help alleviate the inevitable confusion when conveying your wishes to the doctors. Advance directives explicitly state under what conditions specific medical procedures should and should not be used. This makes it much easier to bridge the language gap between doctors and the advocate for the patient. Advance directives can be incorporated into the health care proxy, or can be specified on separate document.
Jane and I completed a health care proxy with advanced directives. When Jane was diagnosed with dementia, I knew that those advanced directives were now in force. After a heart attack caused her kidneys and liver to start shutting down, I knew that the time for heroic measures had passed. Incredibly, I had to argue my case with the emergency room doctor. But the presence of that document and those directives carried the day. My wife was moved to a hospice room and allowed to die in peace.
I love my wife more than life itself, but because we had talked about the situation so exhaustively, letting her go was the easiest decision I ever made.