End of Life Choices

How Life Ends:

Death is Inevitable. A bad death is not.”

The end of our life is natural and inevitable. Few of us, however, come to terms with this at a time when we are still capable of planning for a good end to our lives and sharing those plans with others. Supporting and encouraging this planning process has been my mission for many years and is the underlying reason why I produced the film, Speaking of Dying. Imagine my surprise when I discovered our Speaking of Dying mission was shared on the cover of the April/May, 2017 Economist magazine.

The Economist is a British magazine founded on the principle of  ”taking  part in ‘a severe contest between intelligence, which presses forward, and an unworthy, timid ignorance obstructing our progress” . Intelligence versus “timid ignorance” certainly fits end of life issues and challenges.

I read the magazine on my return trip to Seattle following a vacation visit with friends and family in Kansas. The Economist cover story contains the following alarming statistic. “By 2020, 40% of Americans are expected to die alone in nursing homes.” The article continues by noting that although 51% of Americans over 65 have supposedly written down their end-of-life wishes, it remains a futile exercise if:

  1. Individuals do not fully understand their choices,
  2. There is no plan as to how to carry out the wishes
  3. No one else knows for sure what the plan is.

While in Kansas I screened the film at a senior center in Hutchinson for 40 people. The audience’s questions and comments about the film movingly illustrated the concerns voiced in the article. An elderly couple spoke of their daughter’s recent death from pancreatic cancer and their struggle to understand her choices and give her the death she wanted. Another woman said she was eager to buy the film and see if she could begin conversations with her adult children who did not want to discuss  her end of life care with her, or with each other.

Once we resolve to deal with these matters, our next step is to determine how far we want to go to be kept alive. In the Economist article, the writers say “the chief responsibility for the failure of end of life care lies with modern medicine. “In its calling and mission to heal us and keep us alive, modern medicine has also has devised and invented many ways to keep us breathing and barely alive much longer than we might wish. This results in many more people outliving their support systems and resources and dying alone in nursing homes with a diminished quality of life. Learning more about the medical possibilities ahead of time, and talking about them, can give us, or our representatives, the courage needed to ask important questions about the goals for our care when our time comes.

As both the article and the film point out, there are many available end-of-life options that can assist in a better death. Some of them are: Palliative Care, Hospice, discontinuing treatment, VSED (Voluntary Stopping Eating and Drinking), Palliative Sedation and the new Death with Dignity laws in some states. In the film and with this blogsite, our goal is to introduce and clarify many of them.

Let us agree that we need to think deeply about our end of life wishes and desires and write them down. We also need to choose a Medical Power of Attorney who can support us and carry out our wishes if we can no longer speak. In addition, we need to have discussions with our primary care physician and any other specialists who are treating us. If we do these things, there is a significantly greater possibility that we will have the peaceful, meaningful death we all hope for.

A “bad death” is not inevitable. Planning for a good death is possible. It is up to you.

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