Advance Directives Ease the End-of-Life Choices

I read an obituary last week that gave me pause. It was for a Mr. John Davis who died at age 87, peacefully, at home surrounded by his loving family . . . a true marvel in this age of chronic illness, high tech medicine, an incredible array of medications for every ailment and frequent hospital admissions for the elderly. I’m envious!

Too often we die alone in a hospital bed these days, surrounded by machines that beep and blink, tubes in nearly every orifice, hoards of interns, residents, and nurses doing their jobs prolonging life at any cost of instead of allowing us to die a natural death. We seem be so much better at preserving life at all costs than we are letting it go when it’s time.

My Personal Experience

In the interest of my own end-of-life concerns, I have signed advance directives giving my adult children the responsibility of making end-of-life decisions for me if I am unable to do so for myself and I have spoken to them about this innumerable times. I know full well that when such a time comes they will have to make wrenching choices between maintaining my life even if there is no quality left, or letting nature take its course.

Aunt S

I was called upon to make such wrenching choices three times in my life and it was never easy. The first time concerned my dear widowed Aunt S. who was 89 years old, in the hospital and terminally ill. She lived alone in Chicago and had no remaining family. My brother, Dick, and I held her health care power of attorney, but Dick was out of the country when her doctor called me.  Aunt S. was not eating and had been refusing food for several days.

The doctor asked if I wanted to have a feeding tube surgically implanted.  Mindful of my aunt’s Advance Directives, I said no, hung up and immediately regretted what I had said. I felt the full burden of choosing to let my aunt pass and was absolutely panicked by my choice. I quickly called my Aunt M. who lived in St. Louis. She was the younger sister and closest friend to ask if that was alright with her. There was still time to undo my words.  Aunt M. was frankly relieved to have her sister’s suffering finally end and completely supported my decision to say no to tube feeding. Aunt S. died a natural death in the hospital within the week.

Mother

The second time I was called on to make a wrenching choice was somewhat easier because Mother was clearly dying from end stage Alzheimer’s disease. The issue was not about giving or denying treatment but rather about whether or not to bring in Hospice care to ease her passing.   Of course I opted for Hospice and only wish I had known about and engaged their services sooner. They were with me at her bedside in the nursing home to administer morphine when Mother’s breathing became labored. So Mother’s passing was smooth and without a struggle.

Mark

You would have thought I would now be used to being in the position of having to determine the direction of the end of life care for the elders in my family, but not so. When several years later I was called upon to make choices regarding my step-father, Mark, I fell apart! The nursing home reported that Mark had a high fever and was going into heart failure and wanted to know if I wanted him to go to the hospital. He was 98 years old, had dementia, was weakened by a stroke and had little if any quality of life. I did not give permission for him to go to the hospital and since Hospice had already been involved with him for some time, requested that they keep him comfortable and let him go peacefully.

And then I got totally hysterical! I began sobbing uncontrollably. Maybe it was because I was losing my last parent and would from now on be an adult orphan. Maybe it reminded me of the still raw loss of my mother. Or maybe it was just the overwhelming sense of responsibility for the lives of others. In any event, I had the good sense to call the Hospice hotline and talk with the young social worker there.

She sounded about 12 years old, but of course was not really that young and had the wisdom of her training. After she calmed me down by listening to my story, she asked me two powerful questions: Did my father have Advance Directives, and did I know what was in them? I answered yes to both questions. And told her that he was clear that when he was at the end of his life, he wanted no heroic interventions, no hospitalizations but simply to be allowed to pass in peace and comfort.

Her next remark was magical and released me from the responsibility of decision making. She pointed out that I had not made the decision to refuse treatment, but was really following my father’s wishes and instructions. It was his choice, not mine!

In that astonishing moment, the monkey flew off my back. I stopped crying and was able to think clearly.  I had done just exactly what my father wanted me to do. He died peacefully that night. I was not able to be with him but was content in the knowledge that I had done the right thing.

PEARL OF WISDOM

Start the conversation with your parents about their end-of-life wishes.  The more you know, the easier it will be to carry them out. Check out the Five Wishes from www.agingwithdignity.org. It is a great vehicle for having this important discussion and getting it in writing!

© Joan Blumenfeld, 2013

PEARLS OF WISDOM is written by Joan Blumenfeld, MS, LPC, a Geriatric Care Manager in private practice in Fairfield County, Connecticut. This blog is intended for general interest only, not as advice for specific cases. To make an appointment for a private consultation, please call 203-845-0191.

Website: www.joanblumenfeld.com

Email: jbeldercare@sbcglobal.net