Five Wishes

A Living Will is Not Enough

September 24, 2012 By Carolyn Parr Leave a Comment

In previous postings we have exhorted you, dear reader, to make sure you have a living will or an advance medical directive so that your loved ones and your doctor will know what kind of care and, eventually, death you wish to have.

In the past we have referred you to Five Wishes and to the Annual Health Care Decisions Day (the next one is April 16, 2013) as important resources. But instructions and documents are not enough. The process is incomplete without a conversation with your children, your parents, spouse or anyone whom you want involved in your end of life care.

Completing an Advance Medical Directive can be a challenge. But what people often find more difficult is the conversation that needs to take place before preparing the document.

Let’s face it: Too many people are dying in ways they wouldn’t choose, and too many of their loved ones are left feeling bereaved, guilty, and uncertain.

Which brings me to The Conversation Project. Founded by the noted columnist and writer Ellen Wilson, it is a resource to guide us through the often sensitive process of discussing end of life plans with loved ones. Ellen writes that she didn’t have this conversation with her Mother before she got dementia. As a result she was faced with myriad decisions she had no way to resolve because she never had “the conversation” with her Mom.

For those of you who are unsure when and how to have the conversation with a loved one, check out www.theconversationproject.org. It features an easy-to-download guide to initiating and carrying out these talks that should make the process much easier.

Sig Cohen

The Toughest of Conversations?

April 2, 2012 By Carolyn Parr Leave a Comment

How do I want to die? Where do I want to spend my last days? And with whom? These are some of the questions thoughtfully posed by the award winning documentary, “Consider the Conversation.”

This 2011 production is a rare find. Consisting of interviews with hospice workers, doctors, an ALS patient, and numerous others, it raises profound questions about how we both hope and plan to spend our final days.

In an accompanying study guide (www.considertheconversation.org) the producers state that their goals include changing the commonly held American view that end-of-life is a failed medical event rather than a normal process rich in opportunity for human development.

Second, they seek to inspire dialogue between patient and doctor, husband and wife, parent and child, minister and parishioner.

Third, they want to encourage medical professionals, healthcare workers, and clergy to take the lead in counseling others about end of life issues.

The documentary does not offer answers. Instead, it provides questions all of us need to contemplate and answer for ourselves. The film elegantly aligns these questions with the concept of advance care planning which is all about talking with patients and loved ones about their end-of-life wishes, documenting them, and taking action to ensure they’re honored.

Other questions the film asks are: At what point is the quality of life no longer worth the emotional and physical costs of maintaining it? When is it OK to acknowledge that one has fought the good fight and it’s now OK to accept moving to the next phase? Have we had a tough conversation with our doctor about end of life planning? Will our doctor be honest and courageous enough to tell us when there is no more she can do and not consider that a medical failure but a fact of life? When is enough, enough?

Every so often we find a resource that challenges us to engage in a Tough Conversation. So it was with Five Wishes which provides a caring and intelligent approach to creating a Living Will. How to Say it to Seniors by David Solie is another gem that guides our thinking about what it means to be an elder and how to communicate effectively with elders. And so it is with Consider the Conversation, a thought provoking journey into what too many of us consider taboo territory.

For PBS listing or to purchase the film see www.considertheconversation.org.

Sig Cohen

Tube Tales

September 25, 2011 By Carolyn Parr Leave a Comment

(The following stories are true; only the names have been changed.)
1. My friend Linda’s grandmother was in a coma. The doctors had put her on life support. After several months in this condition Linda’s mother, Gail, was unsure how to proceed even though she was named grandmother’s health care proxy. So Gail invited the 12 closest family members to grandmother’s bedside. Once assembled, she asked them to vote on whether to remove life support. Nine voted yea; three nay. Life support was withdrawn, and grandmother died within hours. The three nays realized that removing life support made sense and were relieved to know that grandmother expired painlessly.
2. Twenty years ago Stuart moved to Washington having renounced his family ties. We knew nothing about Stuart other than he had previously lived in upstate New York. Stuart developed a virulent form of abdominal cancer, which went untreated. While visiting a friend his condition deteriorated such that he was taken by emergency vehicle to a nearby hospital, placed on life support, and administered morphine. Stuart had no living will nor a DNR order. (Do Not Resuscitate.) His friends were at a loss how to proceed as was the medical staff. After three days the doctors decided to reduce the morphine drip to the point that Stuart regained consciousness. When he did, a doctor asked him what he wanted to do. Stuart mumbled that he wanted to ‘go home.’ His answer gave the doctors sufficient justification to remove life support and transfer him to a hospice where he died a few days later.
3. When my cousin Joan’s mother was admitted to the ICU of a local hospital, it was clear that she might never regain consciousness. Joan’s older brother, Sam, was her mother’s health care proxy. Both Joan and her younger sister Carol did not want their mother to remain indefinitely on life support. Sam did, and because he was named health care proxy, he prevailed. Their mother remained in a coma for the next two years before she passed away. Given the sisters’ anguish over their mother’s prolonged coma and the huge cost the family incurred, they haven’t spoken with Sam since.
Moral of the stories? Plan ahead. Make sure that everyone in the family whether they suffer from a chronic disease or not has a living will or a health care power of attorney, or proxy. Try to reach consensus on whether to use life support or allow nature to take its course. One of the best tools we’ve found is “Five Questions” which has become America’s most popular living will because it is written in everyday language and helps start and structure important conversations about care in times of serious illness. See www.agingwithdignity.org.
Sig Cohen