However, I discovered that when it came to end-of-life wishes and funeral plans, he had left no information. I always assumed that he and my mom had discussed these things, but they never did. As is turned out, a do not resuscitate (DNR) or healthcare proxy was not needed, but I couldn’t help wondering what would have happened if he had been put on a respirator or other life support. Did he want those measures taken? Not knowing his wishes would have left us with a heart-wrenching decision. As far as funeral plans, I suspect my dad didn’t really care. He would have been happy to have a no-frills affair involving a fishing boat and some cold beer! But since we didn’t know what he had in mind, we did our best to plan a funeral that included the things he loved, lots of wonderful memories, and the many people whose lives he touched.
After the dust settled, and my mom and I had some time to just sit and talk, we decided that the two of us needed to have some important conversations. Thankfully, she realized the significance of putting her affairs in order and expressing her wishes, so we consulted an attorney and created a living trust, with me as trustee. In the process, we talked about everything, from what she wanted to wear at her funeral (“Bright red, because I’ve never been a demure, pastel person,” she declared.) and what music to play (“Something upbeat, please.”), to starting a small college fund for my son. We discussed her end-of-life wishes and she signed a DNR. We took a financial inventory and made a budget. These discussions were sometimes difficult, but they were also some of the most meaningful conversations we had. And, once the documents were signed, copied, and put safely away, we felt a sense of relief. It was reassuring to both of us that things were in order. It occurred to me that we should have had these conversations much sooner, but at least we had them before it was too late.
On our way home from the final visit to the attorney’s office, my mom let out a big sigh and announced, “Well, now that that’s done, we can concentrate on more pleasant things.”
“Like what?” I asked, though I had a sneaky suspicion.
She replied, “Stopping for a hot fudge ice cream puff, of course.”
I knew it!
Looking Ahead
When asked, most people agree that having conversations about end-of-life wishes and putting their affairs in order is important, but studies show that nearly 44 percent of those 45 to 65 years old do not have a will or advance directives. In 2013, a national campaign called the Conversation Project conducted a survey that revealed that 94 percent of Americans felt these discussions were important, but less than one-third actually had these dialogues with loved ones. Furthermore, while 60 percent of those surveyed felt that making sure their family was not burdened by difficult decisions was “extremely important,” 56 percent of respondents had not communicated their end-of-life wishes. The campaign, which is aimed at helping people initiate discussions about end-of-life wishes, found a variety of reasons why folks hadn’t broached the subject, including: “It never seems like the right time,” “I don’t want to upset my loved ones,” “I’m not sick yet,” and “I don’t know how to start the conversation.”
These conversations are especially important if you are providing care for someone, but ideally, they should occur much sooner. Accidents or sudden illnesses can strike at any age, which means all adults should have advance directives in place. Obviously, the best time to discuss end-of-life wishes and the type of care preferred is before a health crisis occurs, and the person is under duress. Aging, illness, trauma, and even medication can make it impossible to have meaningful conversations, and no one wants to make hasty choices in a time of crisis. By preparing in advance, you can reduce stress for yourself and your loved ones and make educated, thoughtful decisions. Think of it as a gift for both you and your loved ones.
Legal Documents
Having honest, open conversations is a great starting point, but the decisions must be put in writing to be legal. Often the term “advance directives” is used to describe several legal documents that describe a person’s preferences regarding treatment if he or she experiences a serious accident or illness. These legal documents speak for you (or your loved one) if you are unable to speak for yourself. If a person is unable to make their own healthcare decisions, family members and physicians will consult a patient’s advance directives for guidance. These documents typically include:
A Living Will—A legal document used to outline a person’s wishes regarding life-prolonging medical treatments, such as a respirator, ventilator, feeding tube, or resuscitation. It may also be referred to as an advance directive or healthcare directive. Because laws differ by states, be sure to consult an attorney to find out what your particular state requires. Living wills are essential because they inform family members and healthcare providers about an individual’s preferences for medical treatment in the event that he or she becomes incapacitated. (It’s important to note that a living will is different than a living trust, which is used to hold and distribute a person’s personal assets.)
Medical or Healthcare Power of Attorney (POA)—This legal document, which may also be called a Durable Power of Attorney (DPOA), designates an individual to make medical decisions for someone if he or she is unable to do so. This person, referred to as a healthcare agent or proxy, is only able to make healthcare decisions. This differs from a power of attorney, which authorizes someone to make financial transactions for an individual if he or she is unable to do so.
Do Not Resuscitate (DNR) Order—This is a written request to forgo resuscitation efforts such as cardiopulmonary resuscitation (CPR) or advanced cardiovascular life support (ACLS) if a person’s heart stops or breathing ceases. It may also be called a “No Code” or “Allow Natural Death” directive. Advance directives do not have to include a DNR order, and a person is not required to have advance directives in place to request a DNR. A physician can put a DNR order in an individual’s medical chart. Keep in mind, many states require a separate DNR form, which is state-specific and bears the signature of a physician. A living will that states DNR wishes is not usually sufficient.
Starting the Conversation
Talking about death and dying can be difficult, but having these conversations can actually bring peace of mind and make things easier for everyone involved. If you’re finding it tough to broach the subject with a loved one or make your own wishes known, you can visit www.theconversationproject.org, which offers a helpful “Starter Kit” along with other valuable advice. The kit gives you step-by-step instructions for thinking about what matters to you most, deciding how much information you would like to receive as a patient, and how long you want to receive medical care, as well as how involved you want loved ones to be. It even includes conversation starters, such as “I was thinking about what happened to ________ , and it made me realize how important it was to have a talk.”
The Conversation Project also offers these tips when having a discussion with loved ones: