Advance Directives: The Documents That Let You Die With Dignity
It’s time to think about the kind of care you want — and don’t want — at the end of your life
The last time I saw my father, he was in the last stage of Alzheimer’s, confined to bed with pneumonia and terribly frail. He could no longer talk, recognize me or even open his eyes, but when I said “I love you,” he smiled with heartbreaking sweetness.
Later my aunts came by and sang “Amazing Grace” by the bedside in three-part harmony. Eyes closed, my father made a small rattling sound in his throat in response. At first I thought he was in pain, but later I realized: He was trying to sing.
Before his illness, my father was emphatic that he wanted a natural death. He didn’t want to be kept alive while hooked to machines in a hospital, and he especially detested the idea of a TV blaring in the background. But when he died three days later, he came close to losing that wish.
The firefighters and emergency techs who rushed in tried to clamp on pads from a defibrillator to shock his heart back to life, but my mother threw herself in front of them. “No, no, no! He doesn’t want to be resuscitated!” she screamed. The men were no doubt shocked by the sight of the small woman playing bodyguard and screaming for them to leave her husband alone. But incredibly, they did.
Today, this wouldn’t happen: If your heart stops, emergency personnel and healthcare providers are required to do CPR unless there is an advance directive telling them not to take any “heroic” lifesaving measures to do so. And that would have been another tragedy: My father would have been denied his right to die with dignity.
Thousands, perhaps millions of Americans could face just that tragedy because they don’t have an advance directive, a document that expresses your wishes when you can no longer speak for yourself to help ensure you get the medical care you want — and not the interventions you don’t. To call attention to the problem, attorney Nathan Kottkamp started National Healthcare Decision Day. It’s a day to “inspire, educate and empower” the public and healthcare providers about the importance of advance care planning.
Simply put, National Healthcare Decision Day is an initiative to encourage patients to express their wishes for end-of-life care" and for providers and facilities to respect those wishes, whatever they may be,” according to the NHDD.
We've written about advance directives, including why you need one and how to create one. If you don’t have an advance directive, read the article to find out how to get one now.
According to Kottkamp, one of the most important things you can do in addition to creating an advance directive is to designate an agent. You’ll need this person “to stand in your shoes if you can no longer speak for yourself,” he told a reporter. You can also create a living will and put your wishes in there, he added.
Kottkamp said that it’s good to avoid “always” and “never” in the living will — for example, he said, you might say “never put me on artificial respiration, but what if you were in a car accident and needed that just to stabilize you? You might say ‘I wouldn’t like artificial respiration unless it was to stabilize me temporarily, not for long-term care.’”
For more information on advance directives, you can also check out the American Bar Association toolkit, which helps people how to go about making the complicated decisions involved. You can also find a goldmine of public resources on the NHDD site.
Talking with your parents now about the kind of care they want for the end of their life is hard, but not as hard as standing by helplessly as your loved one suffers one painful, unwanted intervention after another. Not long after my father’s death, my mother sat down to sign a will and other legal documents with me regarding her own future. Among them was an advance directive.
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