“End-of-life planning is one of the few actions within the power of individuals who wish to help themselves and their society. Too few Americans are shouldering this responsibility.”
Each of us has a responsibility to think about and discuss our wishes about our own end of life. If we don’t do this, someone else will have to take over that responsibility if we become incapacitated. While our main concern may be comfort and maintaining dignity, our family may want to extend our life by any means possible. If we have discussed and documented our wishes beforehand, it is much more likely those wishes will be honored at the end of our life.
To do this, we must first confront any fears and concerns about our own dying process. Making a list of what is most important may help organize our thoughts. Discussing these topics with friends and family ensures that everyone understands what we want or don’t want. The physician may be consulted about any medical decisions that may have to be made, especially if a terminal diagnosis is already known. Many people want to ensure their right to refuse treatment is upheld, but others may insist on receiving treatment no matter what the prognosis.
“But public opinion polls consistently show that most Americans, like my mother, worry about too much rather than too little medical intervention.”
Several forms of advance directives are available and should help clarify our wishes. We can appoint someone we trust to act as proxy for us should we become incapacitated. These measures can help ease the burden felt by the family.
It is a difficult task to shoulder the responsibility for end of life decisions for someone else when you don’t really know what the dying person’s wishes are. You may forever regret the decisions you make for the dying person, and your own grieving process may become complicated because of that. My parents had living wills in place long before they needed them. My siblings and I each had a copy of their living wills and had discussed the contents with both of my parents. We were all in agreement when the time came to make decisions for end of life care, first for my mother and then for my father a few years later. A very difficult time was made a bit easier due to advance directives and thoughtful communication.
“The worst imaginable horror for my mother was that she might be kept alive by expensive and painful procedures when she no longer had a functioning brain. She was equally horrified by the idea of family fights around her deathbed.”
While my parents belonged to a cohort that accepted medical paternalism, I grew up questioning everything, including physicians. I did have to advocate for both my parents at the end of their lives and questioning the medical professionals charged with their care was part of that process. Physicians are obligated to do what is best for the patient, but they should not make decisions for a patient, especially those that require a moral or preference judgment. The patient’s autonomy should be respected, and the patient’s right to self-determination should be upheld. Patients have the right to question their physician at any time during the course of their care.