A recent Medscape health bulletin contains a remarkable personal story by sociologist Margaret Nelson called
Listening to Anna,
about the difficulties that family members, those given 'durable power
of attorney', and executors of 'living wills' face trying to decide
what is 'best' for a suffering, terminal, and/or incapacitated patient.
Most of you don't know it (or don't want to believe it) but at
some point in your life there's a high probability you will have to
make such a decision. It will present you with several serious
quandaries:
- The wishes the patient expressed in a healthy, rational moment may
appear significantly different from what you perceive his or her wishes
to be at a critical stage of illness.
- Those wishes may also be at odds with what you think you would want in the same circumstances.
- You
may not know the patient's personal views on using extraordinary means
to extend life, especially if great or continuous pain is involved.
- Frequently, 30% of life-long health costs can be burned through in
the last six months of a person's life, and if costs are not fully
covered by insurance, the desire to give the patient the best possible
care can be in conflict with the desire not to burden family and
descendants with unnecessary, fruitless and/or crippling bills.
If that weren't bad enough, the ideologically-crazed Bush
Administration has waded in, with its outrageous, Taking Care: Ethical Caregiving in Our Aging Society 'recommendations', including this especially egregious one:
Advance instruction directives (or living wills), though valuable to
some degree and in some circumstances, are a limited and flawed
instrument for addressing most of the decisions caregivers must make
for those entrusted to their care.
In other words, as demonstrated in the Schiavo debacle, if doctors and loved ones do not
do everything possible to keep a patient
alive, at any cost, the state licensing authorities and the government
may choose to investigate, censure, intervene, override, and impose its
values on your personal decisions.
Whether or not you live under such a regime, if you want
to spare yourselves and your loved ones the agony and cost of uselessly
and painfully prolonging the terminal period in your life, you need to
ensure you and your loved ones have the kind of clauses Anna had in her
living will:
In the event that I suffer from a condition in which there
exists no reasonable expectation of (a) my recovering the use of my
mind, memory, and imagination, and/or (b) recovering the physical and
mental resources needed for living with adequate independence from
medical, mechanical, and nursing support, then I want to be allowed to
die as quickly and painlessly as possible.
If I suffer a condition from which there is no
reasonable prospect of regaining my ability to think and act for
myself, I want only care directed to my comfort and dignity, and
authorize my agents to decline all treatment (including artificial
nutrition and hydration) the primary purpose of which is to prolong my
life.
Most
boiler-plate living wills/health powers of attorney do not have such
specific clauses in them -- they refer only to the right and
responsibility to make "personal care decisions" in the case of a
patient's incapacity to do so.
And then, once you
and your loved ones have these clauses in place, and a wallet card to
indicate to medical authorities you have a living will, you all need to
be
ready to do battle with family members and/or doctors and/or government
meddlers with their own personal ideological agenda who will try to
overrule the clear wishes stated in these clauses. This will come at a
time when you and your loved ones will be especially vulnerable to
doubts and coercion -- sleepless, exhausted, stressful times when this
unneeded and unhelpful outside pressure will only make matters much
worse.
I keep saying it is not in our nature to plan ahead, to
prepare for unforeseen eventualities. But after reading Anna's story,
I'm damned well going to make sure that these clauses are in my living
will, and that I sit down with each of my loved ones and make
it absolutely clear in everyone's mind that, if and when the time
comes, I am counting on them to have the courage and integrity to pull the plug.
You're my witnesses. D--N--R. "Don't leave 'em nothin' to work on."
Category: Being Human
MADE IN CANADA
trust your
instincts 
