Planning for End-of-Life

No one likes to think about the end-of-life, let alone consider questions about how one's final days will be spent. It's important to remember that we have medical choices that weren't available even 50 years ago. Planning for the end of life makes sense for everyone, regardless of health or life circumstances.

Thinking it through

It's always best to make important decisions without pressure. You need to understand your options and take time to consider what will help you reach the end of your life with dignity, comfort, and a sense of control.

Making your wishes known now also gives you assurance that your preferences will be respected and followed, in case you are unable to speak for yourself later. By planning ahead, you also spare your family from having to make difficult decisions without your guidance.

Many life-support options are now available to seriously ill people. A dying patient may be offered a breathing machine, cardiopulmonary resuscitation (CPR), or intravenous or oral tube feedings to prolong life. How you feel about all the medical care options is deeply personal. Thinking and talking about a "best-case plan" with your providers and family now will help take the pressure off you and your loved ones later.

How to begin

First, keep in mind that end-of-life planning is a process; your feelings and wishes may change over time. Once you have put a plan in place, you always have the right to change your instructions. The best place to start is thinking about what matters most to you. Write down these thoughts. Then start talking with your providers, loved ones and anyone else willing to address the topic thoughtfully. Think about the values and beliefs that are important to you and discuss them.

Some points to consider:

Life quality. Is it more important to live as long as possible or to preserve a good quality of life, even if it means not living as long?
Life support. How do you feel about life support machines? Should they always, sometimes, or never be considered? Talk with your provider to learn about interventions you may be offered. Remember, some life support measures, like a breathing machine, can be used to get you through a short-term difficulty. So, you should make it clear that you only want measures not performed if they would be required permanently.
Pain relief. How important is it to be kept as pain-free as possible? Do you prefer pain medication that will allow you to stay mentally sharp?
Spiritual values. Are there certain medical treatments or procedures that go against your religious beliefs and traditions?
Final days. Would you prefer hospitalization or home care? How do you feel about hospice care? Hospice is medical care that emphasizes pain relief and emotional and spiritual support without aggressive medical care.
After death. How do you feel about autopsy or organ and tissue donation? Are these things you would want?

Write down your wishes

Once you sort through your feelings, you must write down your preferences so that your caregivers and providers know how to care for you. Your message to your providers is known as a living will, which is a legal document called an advance directive. Legal forms vary from state to state. You can check with a lawyer about what you will need, or you may find free forms and help by visiting the National Hospice and Palliative Care Organization website. Any forms you use must be signed, dated and witnessed.

It's best to be as specific as possible. Avoid vague statements such as, "Just let me go peacefully." In a crisis situation, caregivers need clear direction; this also helps avoid conflicts. Make sure that your family, friends, health care team and hospital or other providers all have a copy of your advance directive so that it can be easily accessed and followed.

Your personal advocate

You will need someone to make decisions for you if you aren't able to do so. The person you choose should be named in a legal document known as a durable power of attorney. This person is often called your "health care proxy." Pick someone who understands you, respects you and your wishes, and can make difficult decisions in times of stress. Explain your end-of-life preferences and ask if he or she will honor your wishes. If the answer is yes, you've found your advocate.