Planning for the future: There’s no time like the present
Thursday, December 12, 2019
The holidays are upon us. There are gifts to purchase and wrap, parties to plan, potluck dishes to prepare and lights to string. Inevitably, many of us will share in some festivities with our close family members, flying or driving to see them, enjoying shared meals and hopefully some joyful reminiscing.
For those of us who work in healthcare, we know that the gifts of good health and time shared with loved ones are precious. What we may not think about is that these hours or days together are an opportune time to take care of a very important matter: Planning for the future and establishing advance directives.
I know, I know…discussing matters such as ventilators and artificial nutrition in between baking cookies and wrapping presents does not sound super-festive. But the value of these sometimes-tough conversations is priceless and too often we forgo them because there is no “right” moment. Well, guess what? We can create that moment.
In their new book, "A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death," authors B.J. Miller, M.D. and Shoshana Berger outline the practical steps each one of us can take to ease stress and distress and live life fully up until the end.
Their book is a gem — it’s the first of its kind to guide readers towards planning for the end, addressing the financial, emotional, medical, physical and spiritual aspects of living and dying. Through a detailed look at the tasks that will help one to better prepare for the end, Dr. Miller and Berger invite readers to engage in difficult conversations and thereby begin to chip away at the stigma of death and dying that exists in our society.
All of us can benefit from discussing our healthcare wishes with our trusted friends and family. As an oncology and palliative social worker, I have seen the devastating impact of not having these conversations too often — patients who suffer needlessly because family is arguing over pursuing aggressive treatments versus allowing for nature to take its course.
Patients caught in the middle of family conflict and unable to verbalize if they want to continue with curative treatments or opt for comfort care instead. And family members suffer, too. They question whether or not they are doing the right thing.
I have had spouses agonize over the decision to discontinue a ventilator. “I feel like I am killing him!” I have heard not once, but several times over the course of my career.
In my father’s final weeks of life, I realized the power of his having established advance directives. He lived with and died of laryngeal cancer. Towards the end, the symptoms were awful, but the hospice care and comfort provided were a balm. In his final days he was unable to communicate his wishes, but his voice was nonetheless heard and his wishes honored.
We are in a season of celebrating life and light and joy. We gather with family and celebrate and sometimes quarrel and hopefully always laugh at the end. Give the gift to one another of setting aside some time to discuss your wishes.
Take a half-hour and complete advance directives. Choose a healthcare surrogate and let them know that you have done so. Encourage your patients, your friends and family members to also take advantage of time together to do advance care planning. The forms are available online and most states do not require the form to be notarized — just two witnesses are needed. AARP has a link to advance directive forms and instructions by state.
Discussing your wishes, planning for the future, and documenting what you want and do not want at the end of life are some of the greatest gifts you can give this holiday season. Wishing you much joy and peace…
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