I have been thinking a lot about death lately.
Being an estate planner, I suppose this might be nothing
more than an occupational hazard. After
all, I spend much of my day counseling people about how to get their affairs in
order in advance of their demise. Yet despite my strong commitment to developing
a relationship with clients and to providing supportive assistance as they
navigate what can be a very emotional process, I confess that the process can
become very clinical at times. Day
after day, I confront this topic, and at times I can find myself removed from
the true meaning of the subject matter.
Lately, however, I have come to a very different, and very
personal, place, which bears thought, and which I want to share. There is much to think about here.
Last summer, I read the outstanding book, “Being Mortal”, by
Dr. Atul Gawande. Dr. Gawande is a
practicing surgeon in Boston, as well as a prolific writer on a variety of
topics relating to the practice of medicine.
With great candor and frankness, “Being Mortal” addresses the inevitable
condition of aging and death, and advocates strongly that it behooves medical
practitioners, as well as loved ones, to assess the quality of life on a
personal level for infirm, aged and terminal patients and to ensure that these
patients experience a “good death” with dignity to the very end.
Recently I
had an epiphany. When I work with clients
on an estate plan, one component is a Health Care Proxy. This document appoints an agent with the
legal authority to make health care decisions on behalf of incapacitated and
terminal patients who are unable to make such decisions themselves. The form asks the client to “check the box”
with respect to various types of medical procedures they want provided or
withheld if they are unable to express those wishes themselves at the time
decisions have to be made. But in
thinking about it, I realized that this
document is a limited, clinical document.
It addresses only the narrow issues of actual scientific medical
procedures, but it does not allow the person to address not only the strictly
medical matters, but also what else they may want as they near the end of their
life, even before they are at the point of incapacity. It is just as important, maybe more
important, to take the time to understand that the patient is a person, with
fears, and hopes, and preferences for how they wish to live out the rest of
their days. How do we address the common
issues of loneliness, helplessness and fear?
How do we offer these patients opportunities that will create a better
quality of life from day to day? How do
we determine what constitutes “quality of life “for each patient, which may be
very different from person to person? And
how do we make life worth living at the end, when we are weak and frail and
unable to fend for ourselves any more? We
should be paying attention to those feelings.
Regardless of the patient’s condition, they have the right to express what
constitutes a life, and more importantly, a death, with dignity, and we have an
obligation to honor those wishes.
So what is the message here?
When a senior client signs a Health Care Proxy, I always tell them how
important it is to have a discussion with the agent, and with their family, about
the medical interventions they may or may not want at the end of life. These are very difficult but very necessary
conversations. I have come to understand,
however, that this discussion should not be limited only to the strictly medical matters. The discussion must also include a conversation
about other, non-medical aspects of the end of life. We should also know what they consider “quality
of life” as they near the end, what they fear, what they hope for, and how they
want to die. To me, it’s all about death
with dignity. And we are all entitled to
that.
[With reference
and thanks to the following sources:
“Being Mortal” by Atul Gawande
“Happier
Endings: A Meditation on Life and Death” by Erica Brown
“Lets Have a
Conversation”, a sermon by Rabbi Carl Perkins, September 23, 2015]
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