Preparing for the future

 How to Practice - Clearing out memories after a death leads the author to get ready in advance. 

"Tavia and I swore a quiet oath: we would not do this to anyone. We would not leave the contents of our lives for someone else to sort through, because who would that mythical sorter be, anyway? My stepchildren? Her niece? Neither of us had children of our own."

The talk of the town

NPR does a story on Lacrosse, Wisconsin, “The Town Where Everyone Talks About Death.” About 96% of the residents of Lacrosse have executed advance directives; by comparison, about 30% of adults nationwide have done so. This is the result, the story says, of one man’s efforts to train nurses to begin the discussion with patients and their families well in advance of a serious illness.

In Michigan, a statute [MCL 700.5506] provides for a person to prepare and sign a Designation of Patient Advocate form to permit another person “to exercise powers concerning care, custody, and medical or mental health treatment decisions for the individual” when the need arises. Under section 5508, the patient advocate is authorized to act only if the person is unable to participate in medical decisions for himself.

The patient advocate form is essential for unmarried couples, same-sex couples, and others who do not wish to rely on their nearest relatives to make these decisions for them.

Another available document is the advance directive, sometimes known as a “living will.” This one is not based on a statutory provision, but rather is based on a Michigan Supreme Court decision that held that a family member may only request that extraordinary medical interventions be discontinued if there is “clear and convincing evidence” that this is what the patient wished. A writing signed by the patient, specifying when and how he does not want (and does want) such interventions is the clearest and most convincing evidence.

We normally recommend that both documents be prepared. The advance directive is an excellent reminder to the Patient Advocate of what the individual wants and does not want when the time comes to act. We also make available a special optional form of advance directive, for interested clients, to direct that these decisions be made in conformance with the teachings of the Catholic Church.

It is also important that these issues be discussed in advance, with all interested family members or others, so that the individual’s wishes are known.

A doctor on the end of life

NPR profiles The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life, by Ira Byock, M.D.  His advice to patients about advance directives:

"This is a way for you to take care of your family if a crisis happens and you're unable to speak for yourself, and they, those that you love, will be left to struggle with decisions about your treatment and care ... You can perhaps lessen the burden that they're going to feel as they struggle with these decisions by shouldering it a little bit, by telling them what you think you would want. They're still going to have to fit those values and preference to the particular condition and treatments being offered, but at least you can lighten the load a touch."