Recently, I was teaching a class on end of life conversations and creating an end-of-life plan. As I read stories from my book Parting Ways, some of the ladies in the class said with such gusto,
“That’s how I want to go!”
I beamed at that moment because I realized they got it.
They were inspired by the individuals I read about walking with their eyes wide open and their families prepared into life’s final frontier. By choosing not to deny but instead prepare for the inevitable, these families didn’t waste time spinning blindly in unknown territory. They chose to chart a direction that I like to call an end-of-life plan.
The medical community calls knowing “how you want to go” or “how you want to be cared for at the end of your life” ahead of time—your advance directive. These are legal documents that provide you with a way to convey your decisions and wishes about end of life with your health care team, your family and friends in the event that you can’t communicate later on. I see these advance directives as part of the process of creating an end of life plan.
In my experience, the end-of-life plan is your exit strategy that is a negotiation between you, your family and the medical community. Just like a birth plan determines how a woman wishes to give birth—detailing the birth team, place of birth, individuals she wants present and treatments she wants to accept or forego. The creation of this plan involves advanced communication and planning between her baby’s father, her support circle and her medical team. The process of devising a plan helps her to cope with the fears of being out of control when entering the unknown territory of giving birth.
Likewise, the end of life plan details an individual’s last wishes, legacy for the next generations and an exit strategy to give to a loved one who will be the gatekeeper and advocate of this sacred document. The creation of this plan involves in advance opening the lines of communication with your medical team, researching your options, talking with your support circle, defining where you want to spend your end of life journey, reviewing your life lived and determining what treatments you want to accept or forego. The end-of-life plan is not an easy one to face but having one solidified in your mind and/or written on paper, in my experience, can transform a frightening period of your life into an awe-inspiring journey.
There are several ways that you can start the process of devising an end of life plan. The medical community is versed in
various formats that I’ve detailed in our end-of-life planning section but repeat here for easy reference.
Living Will/ Advance Directive
Your living will is a legal document that is used in the medical field to provide doctors and your family with your decisions about life-saving and life-prolonging treatments, i.e.
life support like a ventilator or a heart shock, in the event you become incapacitated. In this document you state who is your healthcare proxy to carry out these decisions for you. On the National Hospice and Palliative Care Organization’s website entitled Caring Connections, you can download your state’s advance directive. As stated on the site, a living will, allows you to document your wishes concerning medical treatments at the end of life.
Before you prepare your advance directive:
- Get information on the types of life-sustaining treatments that are available.
- Decide what types of treatment you would want or would not want.
- Share your end-of-life wishes and preferences with your loved ones.
Also on the Caring Connections site is information to help you decide ahead of time who would make your medical decisions for you in the event that you are unable and also how you should store this document. This “Health Agent” would be the person who will carry out your wishes in the living will. There are also instructions on how to store your living will. Below are recommendations to ensure it is utilized in your time of need.
- Paper copies or digital copies of the living will must be portable and accessible anywhere in the world.
- They must be available in a timely manner.
- They must be in a safe place, protected from theft, fire, flood or other natural disasters.
Physician Orders for Life Sustaining Treatments
The Physician Orders for Life Sustaining Treatments is a recognized end of life planning document among the healthcare community. The POLST as described on the site allows healthcare professionals to become aware of the patient’s wishes for care and honor them. The POLST form is a physician order that is representative of the patient’s desires and is instrumental in focusing on the conversation before you become seriously ill. The POLST does not replace the Advance Health Care Directive (AHCD). ACHD allows you to name a healthcare decision maker if in the future you are unable to communicate your wishes for yourself.
There is an excellent resource called The Five Wishes that combines the living will and last wishes into one document that can be ordered online. It’s filled with questions and suggests that help your family and doctor know the following:
• Who you want to make health care decisions for you when you can’t make them.
• The kind of medical treatment you want or don’t want.
• How comfortable you want to be.
• How you want people to treat you.
• What you want your loved ones to know.
Last but certainly not least, is writing your ethical will that will guide you in documenting your legacy—the values, wisdom and life stories you want to pass on to your children and grandchildren. This is good instrument to help your family segue into having meaningful end of life conversations. As I always say, first you have to talk about life before you can enter the discussion about end of life.