As a chaplain in a busy hospice service, I see heart-breaking situations every day. One of the most important parts of my work involves helping family members come to terms with the death of their loved ones, and some of the most painful situations I’ve seen arise from situations where advance directives were not in place and the wishes of a beloved family member were not clear. The surviving loved ones in these situations often expressed guilt about having to make these decisions (“I just feel like I helped to kill him…”) and deep pain following the death.
Advance directives instruct your doctors, loved ones, and legal authorities of your wishes. They are “advance” because you think carefully about your choices before you (or your loved ones) are forced by circumstances to do so. An example from my work: a patient suffered a catastrophic and utterly unexpected stroke, leaving her in a persistent vegetative state. This means that there was still activity in her brain stem-she could blink, react to painful stimuli, and digest nutrition (although she could not feed herself and needed a feeding tube.) However, she could no longer talk, meaningfully interact with her family, or make decisions. Her family had to choose whether to continue her care indefinitely or to stop artificial feeding and hydration. What would you want in a similar situation? Would you want to be kept alive and comfortable? Would you want your life to end? Don’t rely on a casual comment to your loved ones. Give them the gift of writing down your exact wishes.
There are a number of good tools for preparing your advance directives. Check with your doctor to see what he or she recommends. If you’re working with an attorney to prepare your will, the advance directives can be part of that process. Think carefully about what you would want and be explicit in your instructions.
Your advance directives will instruct you to name a durable power of attorney for making medical decisions should you be unable to do so. Choose a person you trust and then communicate clearly with him or her about your plans and wishes.
As hard it is to discuss your death calmly, bite the bullet and talk to your loved ones honestly and openly about your wishes. Give your doctor a copy of your advance directives as well as keeping the original in your files.
If your wishes change (mine did, when I began working with hospice), update your advance directives. Keep your loved ones apprised of these changes.
Making your wishes known makes for clarity in your end-of-life care. Give yourself and your loved ones the gift of knowing what you want if you can’t speak for yourself.