Making life decisions before you can no longer do so
“I’m ready to go…any time now, Doc.”
Bill, the elderly man who said this, was not referring to leaving my office or leaving the country. He was talking about leaving his current life. This man, age 78, was one of the most interesting men in my practice. He often would say that he had no formal education beyond grade four. He had, however, parlayed his meagre education and boundless energy into a multi-million-dollar fortune based on cattle farming. He was always the first to step forward with donations for our hospital. His reputation about town as a generous and honest man was well-deserved.
Like so many men of his generation, Bill’s life was drawing to a close. Age, ill health and family problems had taken its toll and he at last felt that at 78 years of age, he had had enough. He certainly did not want to end his life intentionally; however, he felt that very little was left of the life he knew and loved.
When we think about people who dictate how they intend to die we often think of heroic figures out of history like Joan of Arc or the soldiers at Masada in Israel. These people understood that how they died was a reflection of how they lived. Indeed, passing away is the dénouement of your life. As the author of your own life, should it not fall upon you to make sure that this whole process unfolds the way you want?
Unfortunately, at the time of someone’s death a whole number of forces intersect. Many of these we don’t anticipate. Doctors, nurses and the entire health care system typically play an integral role in what happens. Our health care system is designed to preserve or lengthen someone’s life. We do this for everyone, and it is understood that this is the correct and only way to proceed. However, there can be problems.
What about those people who have inoperable cancer or some other incurable disease? Or what about someone who is very elderly and debilitated from a number of illnesses? What then?
These questions seem to come up more and more often for doctors. With more and more elderly people to look after, we are now faced with these dilemmas on a routine basis. The problem is compounded when family members are involved. Often, family don’t quite agree with just how or what the goal of treatment should be. This leaves medical staff profoundly uncomfortable, particularly as it is a tremendously emotionally-charged time, for family members.
What this means is that, without adequate preparation, the end of your life may have little to do with what you wanted.
The best way to ensure that things go the way you want is to use a document called Power of Attorney for Personal Care. This is a legal document that can be obtained from the Government of Ontario. This two-page document has a number of sections that are easy to understand. There is also a booklet that comes with it that will help you to understand how to fill out the form. Perhaps the most important aspect of the form is that it gets you started talking to those very important people who will have a role in how your life ends. For most people, this would include their spouse, children and other close family, and their doctor.
The document allows for more than one power of attorney for personal care and makes provisions for what instructions, conditions and restrictions they will work under. Many people use the document to advise the “attorney” to tell the doctors to not resuscitate or continue their lives if there is no hope for a reasonable quality of life. It is important to note that a health care provider (your doctor) cannot be your power of attorney. It should be a close family member or friend and you must discuss with them, and your doctor, what your intentions are.
It is also of great importance that when you fill out the form, you discuss it with other members of your family, so they know whom you have chosen and what restrictions there are. This is because if you fall ill and something happens such that you can’t make your own decisions, many of the unresolved feelings and conflicts that you may have had with your family may come to the forefront. This makes it that much harder for the doctors and nurses to do their job.
As a family doctor, I welcome my patients coming in and discussing the Power of Attorney for Personal Care. Typically, once it is signed and witnessed, I keep a copy on file and sometimes have a file appended to their hospital chart.
We all want a long, healthy and happy life. At life’s end, we likely won’t have everything we want. We will, however, have a choice as to what kind of treatment we will receive.
Allowing someone to have the opportunity to decide how things will happen offers dignity and respect. This is best achieved with a well-constructed Power of Attorney for Personal Care.
Remember, it’s your life. Write the last chapter yourself.
You can download a Power of Attorney for Personal Care kit at http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/poakit.asp or you can pick one up at most hospitals or government offices.
Source files from Fifty-Five Plus.