Guest Editorial
The Subject (Almost) Nobody Wants to Discuss
Editorial written by Richard Bauer, Retired Chaplain John Dempsey Hospital, Farmington, CT
(Winter 2004)

Generally speaking, news about the promises and accomplishments of medicine is mostly upbeat. A new drug for treating Alzheimer's. An earlier diagnosis for Down Syndrome. There are some clouds, of course: an increase in childhood obesity, the growing numbers of those lacking health insurance, and the ever-escalating costs of treatment. But we seem to be able to do more and more to halt, or at least manage, disease progression … to the point where death feels more like a postponable option than an inevitability for which we need to prepare.

Yet the Grim Reaper inevitably makes his presence known, and there is much to be said for being prepared.

One way of doing this is through an advance directive, a document that tells your family and health care providers how you wish to be treated medically when the possibility for cure dims and the burdens of treatment exceed the possible benefits. Intubation to get oxygen into the lungs? Artificial nutrition and hydration? Resuscitation if your heart stops? Under what conditions, and for how long? An advance directive states your wishes on such (admittedly) unpleasant issues. And by appointing someone to speak for you when you cannot speak for yourself (a health care proxy, or health care power of attorney), you can let your family know who plays quarterback when the tough choices need to be made. You do not need an attorney to fill out an advance directive. Your primary care physician or local hospital can provide one for you.

Does this settle the end-of-life dilemma? Unfortunately, no. Life is complicated. Medical care is complicated. And we do not have a crystal ball telling us precisely what the circumstances surrounding our, or our loved ones', dying will be. What we need for this process is a great deal of patience and wisdom, coupled with excellent communication with our caregivers. Ethics Committees' agendas are filled with cases concerning either giving up too soon, or continuing long past the point of futility.

There is no escaping the grief of dying, or standing by while loved ones die. But it is possible to do it with some measure of courage and grace, and that is an honorable thing to be about.

Advanced Care Directives Not Just for Terminally Ill
(spring 2003)

If you were in a car accident or had a stroke or heart attack, does your family know what kinds of intervention you would want? Advanced care directives help patients control the type of care they receive if they are unable to communicate their wishes. Unfortunately, few people ever complete a directive, leaving loved ones to make life and death decisions on their behalf without guidance.

It is always a good idea to discuss end-of-life care with your physician and family members, particularly if you have a life-threatening condition. While these discussions are never easy, completing an advanced care directive and leaving copies with your family and physician helps to ensure that your wishes are carried out.

Advanced Care Directives vary from state to state. They come in two forms:

Living Will - this document spells out the kind of life-saving and life-sustaining care and treatment a patient wishes to receive in the event of future incapacitation or terminal illness. In Massachusetts, this provides evidence of patient wishes, but it is not legally binding.
Health Care Proxy - this legally binding document allows a patient to name someone of your choice to make health care decisions for you in the event you cannot speak for yourself. You can obtain a Health Care Proxy from your physician or hospital. You can also obtain a sample of the Massachusetts Proxy, as well as other helpful end of life care resources, from the Hospice Federation of Massachusetts and from the Central Massachusetts Partnership Better Ending program.