Sharing Our Thoughts About the End of Life

Beautiful senior business couple is studying documents, using a laptop and smiling while working in kitchen

It’s human nature to avoid thinking about the end of our own life—and yet, if we don’t, it’s much less likely that our final days will be spent in the way we would want to spend them.

In addition, putting off these considerations until the last minute might mean that our families are left with agonizing decisions, and potential conflict regarding the medical treatment you would receive at this emotionally difficult time. If your health condition made it impossible for you to state the treatments you wanted or didn’t want, your family could be left to answer overwhelming questions like these:

  • Would your loved one want CPR or other resuscitation if their heart were to stop beating?
  • Would they want to be put on a ventilator if they could no longer breathe on their own?
  • Would they wish to have tube or needle feeding if they lost the ability to swallow?
  • If they had a life-limiting illness, would they wish to receive antibiotics that might prolong life?
  • If they had progressive dementia, what health treatments would they want?
  • Would they want to be an organ donor?
  • At what point would they want palliative care (care that focuses on pain control and quality of life) rather than aggressive treatment?

Put it in writing

A recent survey conducted by the Kaiser Family Foundation found that when family members are called upon to make these types of healthcare decisions for a terminally ill elder, they feel far more confident that they’re doing the right thing if their loved one has created written documents outlining their wishes.

These documents include statements about:

What you would want. A health care directive or living will is a document that says what kinds of care—including the life-sustaining measures mentioned above—you would or would not want if you were nearing the end of your life. In some states, you can also create a document that would make it less likely that first responders would perform CPR or other procedures on you if you don’t want it.

Who you would want to speak for you. A durable power of attorney for health care, medical power of attorney or health care proxy is a document saying who you would like to make healthcare decisions for you, if a time were to come when you couldn’t speak for yourself. This person would most likely be a relative or close friend.

Almost all Americans say it’s important to create written documents that describe our wishes for medical care, yet the Kaiser Family Foundation survey found that few have actually done so. A second study, this one from the University of Pennsylvania Perelman School of Medicine, confirms that fewer than a third of Americans have completed a living will or named a healthcare power of attorney. Said study author Dr. Katherine Courtright, “The treatments most Americans would choose near the end of their lives are often different from the treatments they receive. Unfortunately, this disconnect can lead to unnecessary and prolonged suffering. Advance directives remain the primary tool for people to communicate their end-of-life care wishes and appoint surrogate decision makers.”

In the process of creating the documents above, it can help to create a personal values statement that articulates your personal philosophy of medical care near the end of life. Talk about it, read about it. Today’s high-tech medical world has created new challenges when it comes to having meaningful, peaceful last years. Many researchers believe that seniors are often overtreated—for example, being screened and treated for slow-growing types of cancer that most likely would not cause a problem in the years a senior has left, and might result in a lower quality of life.

Who can help you decide?

Talk to friends and family. Find out about presentations and discussion groups held at your faith community, senior center, local hospice or senior living community. Consult with a counselor, your spiritual advisor and an aging life care professional (geriatric care manager).

And talk to your doctor. Medicare now covers advance care planning. Your doctor can counsel you as you make these decisions, and help you fill out the necessary forms. Researchers from Stanford Medicine say that patients should talk to their doctors about their “bucket list”—the things they would like to do in their last years of life and how healthcare can support these dreams. Even when a person has a terminal illness, the concept can be helpful. The researchers noted, “If a patient wants to attend a beloved grandchild’s wedding or travel to a favored destination, treatments that could potentially prevent her from doing so should not be instituted without ensuring her understanding of the life impact of such treatments.”

Having these conversations makes it more likely that we will spend our final days in peace and comfort, and that our family will be spared anguishing decisions and conflict during a time that they would rather be focusing on saying goodbye. It is a loving legacy to leave.

For more information, visit the National Healthcare Decisions Day website to find resources for making and sharing healthcare decisions.

Source: Assisting Hands Home Care in association with IlluminAge. Copyright © IlluminAge, 2018.