We all know, deep inside, that our life will come to an end. Few of us want to think about death or terminal illness. And yet if you want your life’s ending to be as you wish, you must be sure you have a clearly designated Medical Power of Attorney. This designated individual is sometimes known as a Health Care Agent or surrogate, or POA for Health Care.
Who would speak for you if decisions had to be made about your care should you suffer a stroke or heart attack today, or if you were in a critical accident without the capacity to speak for yourself?
If you become incapacitated by a degenerative disease, is there someone who knows what “quality of life” means to you?
We have been conditioned not to talk about these uncomfortable topics, or even think about them, until there is a crisis. Uncomfortable decisions made by others may become inevitable and lead to a medicalized death. Unless you have expressed your desires in a designated POA document and to your physician, prolonged, futile, unwanted treatment is frequently the default mode, no matter what the cost-to patient or survivors.
In one of my first Heartwork End-of-Life Workshops, a participant cried bitter tears as she recalled a phone call from another state, telling her to come immediately because her brother was in Intensive Care. They had not spoken for years. When she arrived, in profound grief, they asked her to “pull the plug” because her brother was being kept alive by machines and could not recover. The decision still haunts her. In another workshop, a man told of his father’s long, lingering death with dementia and other painful conditions because family members did not know, and more importantly, could not agree on, what he would have wanted.
Choosing a person or persons as your designated POA means choosing who will carry out your choices regarding life-sustaining treatment if you can no longer speak for yourself. Your POA might be a family member, your partner, or a trusted friend or acquaintance. The choice might or might not be obvious and may not be the person who first comes to mind. It needs to be someone who can stay calm in an emotional situation; someone who can remember and carry out what you wish, who can speak up to doctors, even if it is hard. And it really should be someone who lives nearby—not far away in another state or country. One woman’s first thought was to choose her two sons for that role. Once she learned exactly what the job required, she decided to pick her two daughters-in-law instead. Who will you choose?
I just finished reading a new book, Extreme Measures, by Dr. Jessica Nitter, an ICU physician and a Palliative Care doctor. Dr. Zitter tells many poignant stories about the needless and ongoing suffering happening in Intensive Care Units throughout the country when patients and their families cannot navigate the unfamiliar procedures. “As an ICU physician, I see many cases where patient’ bodies are being kept alive” she says “whether by breathing machines, feeding tubes, dialysis, and/or antibiotics—despite poor prognoses for recovery or return to their previous function. Surveys show that almost no one wants that, and yet without a clear opt-out, we doctors feel obligated to keep such patients alive.”
No one wants unnecessary suffering as their life ends. As a chaplain, I have witnessed how much better it can be for everyone when patients have palliative and hospice care and when they have time and awareness to say goodbye to their life. Choosing a Medical Power of Attorney, spelling out your wishes in an advance directive and reviewing them often with others can make a good ending possible.
Choose someone today. Talk to them. Do the paperwork. Tell your doctor. It is a gift you can give yourself.