Few things make people feel more uncomfortable than talking about death. Whether it is your own death or that of a loved one, people often prefer to avoid these awkward conversations. However, if you think about death as a natural process, that is a part of life, you may find the subject more approachable. We like to decide which house to buy or car to drive, and what to order at Starbucks, and we may make choices about how we die.
Being in control of the things we can manage at the end of our lives, will make that experience more peaceful, and will leave our loved ones with better memories to cherish. If you cannot communicate your preferences when your time comes, your family must make hard decisions on your behalf. They must know your wishes, if they are to honor them. Does your family know how you want to die?
If you have not told your family what you want done at the end of your life, the best they can do is exercise substituted judgment. Substituted judgment is when they put themselves in your place and try to decide they think you would make. They will reflect back on comments you made when someone else went through a similar experience. They will try to remember if you ever expressed an opinion about what you would want or not want. They might examine your values to help them decide, such as whether you value quality of life more than length of life.
The difficulty with putting your family in the position of having to exercise substituted judgment, is that they might not agree on what decisions you would make if you could. Disagreement about life and death issues can do permanent damage to your family, just when they need each other the most. Whatever decision they ultimately make, your family might also have to deal with years of guilt and second-guessing about whether they made the right decision.
Topics to Discuss with Your Family
Consider talking with your family about whether you would want these procedures performed on you, and under what circumstances or limitations:
- Cardiopulmonary resuscitation (CPR) to manually restart the heart
- Ventilator to help you breathe or to breathe for you
- Dialysis, if your kidneys fail
- Surgery that might extend your life a few weeks
- Defibrillation, which are electrical shocks to restore normal heart rhythm
- Tracheotomy, in which they cut a slit in your throat to insert a breathing tube into your trachea
- Feeding tube
- Comfort care medications
Besides medical procedures, talk with your family about whether you want to spend your last days in a hospital, nursing home, hospice care center, or at home. You can select music you want to hear and other environmental details.
With mindful planning, a person’s end-of-life stage can be a loving, meaningful time. Talk with an elder law attorney in your area about the legal documents you must prepare to make sure that your family and medical team respect your choices.
National Institutes of Health, National Institute on Aging. “Understanding Healthcare Decisions at the End of Life.” (accessed January 31, 2018) https://www.nia.nih.gov/health/understanding-healthcare-decisions-end-life
National Hospice and Palliative Care Organization. “End of Life Decisions: It’s About How You LIVE.” (accessed January 31, 2018) https://www.nia.nih.gov/health/understanding-healthcare-decisions-end-life