Tending to the Future Now

Usually at the beginning of the year when writing about healthy aging, it is the time to remind everyone to exercise, eat properly and visit regularly with your physician. All good advice for healthy aging.

However, this is also a good time to contemplate that inevitable time when we will not be physically and/or mentally able to make the decisions that must be made about our health. Any number of medical problems or accidents can move us from a place of self-determination to sole dependence on others for decisions regarding our health status.

If we anticipate right now those times when we may be unable to function, we can make it clear and easier to all what we want done. We can create legal documents called advance directives that explain what we want and who we trust to see that our wishes are carried out.

We all need a living will. The living will is a written document that states explicitly, as well as generally, the kind of care you want and importantly, do not want, should you be unable to express your desires at the time. For example, if I were to have a devastating stroke that leaves me in a vegetative state with no prospect of waking up, I would have a living will that instructs my physicians and family that I do not want life-sustaining care. Quality of life is lost, and it is time to let nature take its course. If, on the other hand, I hope that there is some unknown medical miracle and I expect to be the first to experience it, then I write in my living will that I wish to be maintained on life support indefinitely. These are the two extreme cases, and you may fall in between, but do not leave it up to others to decide. You make the decision now and convey it in writing to those whom you love. You are giving yourself and your loved ones a great gift.

Related to the living will is the Durable Power of Attorney for Health Care. This is a legal document that names an individual or succession of individuals to act on your behalf for any legal tasks, including medical decisions about life and death. This individual becomes your agent when you are unable to represent yourself. Of course, this person should be familiar with your living will and desires regarding health care decisions when you can no longer make them.

The last 15 years of Terri Schiavo’s life were spent in a vegetative state, unaware of her surroundings and unresponsive to those who loved her. She was kept alive because no agreement could be reached between her husband and her parents as to what she would have preferred. This tragedy could have been prevented.

When the case was being widely discussed in 1990, an editorial in The Wall Street Journal asked, “How can it be morally responsible to let a woman die when there are family members pleading to take on the burden of caring for her?” And at the time, Bob Sade, M.D., director of the Institute of Human Values in Health Care at the Medical University of South Carolina, stated: “The question is not what family members wanted for Terri; it is what Terri wanted for herself.” Unfortunately that was in dispute since Terri had not planned for the unthinkable. And the lesson for us here is to be sure our family knows exactly what we want by constructing a living will.

At the time in this space I wrote: “The quality of life matters to many individuals, even more than life itself. Surveys reported that most Americans say they would not want to be continued in a vegetative state with no hope for recovery, losing all their personality and being a tremendous burden to their family, friends and society.”

You can do something about your future now. Dr. Sade pointed out: “Most people do not have an advance directive, despite years of urging and passage of state and federal laws to encourage them.” There is a reason for this – most people do not want to think about their own death or the death of a loved one, much less plan for it. Talking and thinking about one’s own death is simply too threatening and distressing to rank high on a list of conversational topics for most of us, especially as we begin a new year.

Most of us do not have advance directives and living wills. A good new year’s resolution is to go to your attorney and have her/him draw them up. Or, if you cannot afford this, there are forms that you can download from the internet to assist in making your own. Be sure your loved ones know where these documents are.