Thursday, August 16, 2012

Asking “How will I die?”

This article is another one in a series about becoming your own advocate.

AdvocateA blog article from David Ropeik does a nice job of explaining why it is important to plan for your death … more than what most of us do today. This thought process goes beyond having a will, a living will and a power of attorney. They are all important documents, but there is so much more to consider.

Facing, and Planning For, How You Will Die (and why we don't.)
David Ropeik
This blog writes about how we perceive risk, and how those perceptions often don’t match the facts. We’re more afraid of some things than we need to be, and less afraid of some things than we ought to be, and those misperceptions – what I call the Perception Gap - get us into trouble. One of the things we should certainly worry more about, is dying. Not whether we will die, of course, but how. Given all we do to manifest control over how we live, it’s stunning how few of us have made any plans for the nature of how we will leave this mortal plane.

Most of us won’t die from the threats that seem to worry us the most. We will not be murdered, die in a plane crash, or succumb to the effects of climate change. Environmental contamination, terrorism, swine/bird/the next big flu…each may in fact kill a lot of people. But it is a pretty sure bet that most of us will simply get frail, and sick from heart disease (#1 cause of death) or cancer (#2) or chronic lower pulmonary disease (#3) or a stroke (#4), and need progressively more and more medical care while experiencing progressively less quality of life, even progressively less and less actual lucidity or even consciousness. No need to get morbid with the details here. Suffice it to say you and I will make the long goodbye more with a increasingly care-dependent whimper than with a neat clean final bang.

Yet, as likely as this is for most of us, and as commonly as we have watched our elders pass away under these conditions, few of us have made any plans for this part of our lives. As worried as we are about dying, we are not worried enough about how we will die. That Perception Gap poses all sorts of risks, not just for us, but for our families and loved ones who will have to deal with a lot of serious decisions and questions, simply because we haven’t worried enough to ask them in advance.

Whenever we feel like we have control, we are less worried. You probably think you have control over all those unpleasant-to-think-about end-of-life questions, like what should happen if you are unconscious and need machines to keep you alive, or when to say enough is enough when you’re so sick and frail that more and more medical care is having less and less effect fooling mother nature and postponing the inevitable. All you have to do is sit down right now and think through your preferences, and write them down, and assign someone to be your decision maker if you’re not able to make the call yourself. You have the ability to decide. You have control.

But if you’re like most of us, myself included, you have not had this hard conversation with yourself. You have not faced these difficult questions. You have no end-of-life plan, no health care proxy. Why? In part, because you know that whenever you want to, you can. That sense of control let’s you off the hook from having to face some scary unpleasant ugly stuff. That produces a Perception Gap, the risk that exists because your sense of control has allowed you to worry less than you should about a risk that you and your family are one heart attack or car crash or stroke away from having to deal with.

Advance-Statement-Source-BMA - 1995

Below are additional documents and information that will help you through this advocacy process.
  • Another good read is End of Life Decision Making. The first paragraph of the article sums up the article: Americans are a people who plan. We plan everything: our schedules, our careers and work projects, our weddings and vacations, our retirements. Many of us plan for the disposition of our estates after we die. The one area that most of us avoid planning is the end of our life. Yet, if we don't plan, if we don't at least think about it and share our ideas with those we love, others take over at the very time when we are most vulnerable, most in need of understanding and comfort, and most longing for dignity
  • One other PDF document, End of Life Decisions, does a nice job of explaining some of these decisions such as ‘do not resuscitate’ (DNR) and ‘do not intubate’ (DNI).

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