Planning for life’s end is not always easy. For many people, it is a challenge just to face the fact that someday they will die. Yes, it is a fact of life but not everyone is comfortable talking about it. Once one overcomes that obstacle, then the black and white decisions can be made. By black and white I mean “Who do I want to receive my earthly belongings?” “Do I want to be kept alive on machines?” “Who do I want to make medical and financial decisions for me if I can no longer make them?” Those are the easy questions. The harder ones come when one nears life’s end. Many times the decisions are not only hard for you, if you are lucid enough to understand them, but also for your family and especially for those you designated to carry out your wishes. These decisions center around your Healthcare Representative (HCR) (the person you appointed to make medical decisions for you if you are not competent to do so) and your Living Will/Advanced Directive (the document that states you want to be allowed to die a natural death and not be kept alive artificially).

I hear stories all the time about the HCR struggling with the timing of invoking an advanced directive. Again, the ill person has made the decision that they do not wish to be kept alive artificially if there is no medical hope for them, but what exactly does that mean?

First and foremost, regardless of the timing, the proposed medical procedure or even the existence of all these documents, the ill person retains the right to decide his or her own fate so long as he or she is competent to do so. The ill individual can revoke or suspend the above referenced documents at anytime. Therefore, when confronted with questions about one’s medical preferences and choices, it is imperative that the HCR first determine if the person, for whom they are to make medical decisions, is incapable of making an informed decision regardless of the medical diagnosis of his or her mental state. Most HCR’s are picked because of their close relationship to the person. They are relying on the HCR to use their knowledge of them to make these difficult decisions. Therefore, you must first determine if you believe he or she cannot understand the medical issue. If the ill individual has some understanding of what’s going on and can understand the issue, if you take the time to explain it to him or her, then you need to do so and obtain  the individual’s input for that decision at all times giving deference to  that person’s wishes even if they contradict his or her Advanced Directive. If the individual is capable of making his or her own decision, it cannot be emphasized enough that it is his or her life and therefore his or her decision even though the individual named you as the HCR.

Having faced this very issue with my father, I understand how difficult it is to be in that situation and urge you to read my prior Blog “Is it time to Die?” My father was able to make all of his medical decisions himself and the final decision that my sisters and I made, which was to present the Hospital with his Advanced Directive, that is his prior written decision for no further treatment, was made much easier by seeing his prior struggles and suffering. Peace for him was near, and although difficult to accept, it was welcomed by him and us. In the end, while in the ER, although the infection had clearly affected his state of mind, that delirium literally had my sisters and I laughing with him the last time we saw him alive. What a bitter/sweet memory. I prefer to remember the sweet!

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