One of my daughters sent me a text last week that her oldest son, age eight, worried I might die soon.
The cause of his concern was a reference to my turning 70 this coming April. One of his grandmothers passed away at 60 a couple of years ago, so he viewed 70 as a real stretch. My daughter was able to assuage his fears by reassuring him that I am in good health, eat right, and exercise regularly.
I don’t view a number of years lived as a milestone. I’m more an “every day is a gift/milestone, let’s enjoy it to the fullest” sort of guy. Many years I have told people I was a year or two older than I was, simply because I didn’t pay attention to the number.
Even though I tend to focus on the now rather than the then, I do look ahead and plan. In most cases, if you don’t have a goal, and a plan to get to that goal, you wind up lost.
Birth and death are different matters. We are all born, like it or not, and we all die, like it or not. We can all go through life with no plans to die and we will still die. You can go happily down the road of life without a care and Wile Coyote can still drop a rock on your head.
Since death can be so random, what is there to plan for?
A lot. You can plan for how you are cared for in your last days and what will happen when you’re gone.
My wife and I are flying halfway across the country in June for a grandson’s wedding (this one is older than eight). We’ve made arrangements for someone to check on the house and feed our cats.
Most people wouldn’t make such a trip without providing for the care of their property and pets. So, since death is the ultimate out of town trip, it seems wise to pack your bags carefully for a good journey. For some, that means drafting a will. For all of us, it means preparing one or more advance directives.
Types of advance directives
An advance directive is a legal document (advance directives by state) that allows you to dictate your decisions for your end of life care. They often include a living will and or a medical power of attorney. Such directives only go into effect if you are too incapacitated to express your wishes. These documents can only be changed by you.
If you are dying or permanently unconscious, a living will tells health care providers and your family what treatments you want or don’t want. You can include instructions on:
Ventilation
Resuscitated if your breathing or heartbeat stops
Tube feeding
Comfort care
A durable power of attorney for health care is a document that names someone you trust to make health decisions for you if you are unable to do so. We will look closer at these documents and related matters next issue.
Advance care decisions
Where to begin?
Though much of advance directives deal with physical questions, you might want to start by clarifying your personal values regarding how you live your life.
Do you want as many days of life as possible, or, is the quality of life more important?
The answer may not be as straight forward as it seems. Would you want as many as many days a possible, if those days were spent in a coma? If your body was incapacitated, but your mind was still active, would you have enough quality to still enjoy life?
The only right answers to these questions are the ones you choose for yourself.
Talk to your doctor and family
It might help to talk with your doctor about how your current health conditions and how they could influence your health in the future
Your current health conditions and family medical history might give you a clue of situations you want covered in your advance directive. Ask your doctor to help you understand and think through your choices before you put them in writing. Discussing advance care planning decisions with your doctor is free through Medicare during your annual wellness visit.
Deciding what treatments you do or don’t want
Modern medicine has and continues to develop methods of treatment for life-threatening situations. Some of the most common end of life treatments are covered below.
Ventilators. These machines help you breathe by inserting a tube through the throat into the trachea (windpipe) so the machine can force air into the lungs. This is called intubation. You are often sedated in this process because it is uncomfortable. For long-term ventilation, a tracheotomy trach (in doc speak) maybe performed. That involves inserting the tube into the trachea through a hole in the neck. Ongoing sedation is not needed. Because the breathing tube does not allow exhaled air to go past your vocal cords, you are unable to speak without help.
Resuscitation. We’ve all seen the miracle of cardiopulmonary resuscitation (CPR) on television and in the movies. Little Timmy is not breathing. Lassie finds him, jumps on his chest three times, barks and, suddenly the boy is restored to life. CPR might restore your heartbeat if your heart stops or is in a life-threatening abnormal rhythm or if you have stopped breathing. However, the success rate of CPR in elderly hospital patients is about six percent, according to a study by the University of Arizona’s Arizona Center on Aging. Even if successful, resuscitation can have adverse effects on Seniors. CPR requires repeatedly pushing on the chest with force while putting air into the lungs. Electric shocks, known as defibrillation, and medicines might also be used.
Tube feeding. This method is used when a patient can not feed themselves and does not respond to assisted feeding. It involves having nutrients pumped into the stomach. Fluids are provided through a tube inserted in a vein.
These procedures help in recovery from severe illness. “However,” according to the National Institute on Aging (NIA), “studies have shown that artificial nutrition toward the end of life does not meaningfully prolong life. Artificial nutrition and hydration may also be harmful if the dying body cannot use the nutrition properly.”
Comfort care. This is all about relieving pain and discomfort while respecting your wishes. This may include spiritual counseling, limiting medical testing and procedures, relieving anxiety, and nausea.
My grandmother, a few decades ago, and my oldest brother, a couple of years ago, died of cancer. They both died at home, among family, with little to no medications, as they wanted. They were only able to do so because they let their wishes be known.
This may not be the cheeriest subject, but it’s vital if you want a say in your end-stage care.
Tuesday, we’ll look closer at the documents used for advance directives, how to pick a proxy, and what you can do after your advance directive is in place.