In the backs of our minds, most of us have at least a fuzzy idea of wanting a good death. But what does that mean to you and how can you plan for one?
It may not be easy to think about dying and what you want from it. You may have a lot of hard choices to make. But if you plan for end-of-life care, it can bring you peace of mind to know your wishes will be honored.
It also lowers stress on your loved ones. They won’t have to guess -- and maybe disagree -- over what they think you would have wanted.
Types of Care
An important question to ask yourself: How much treatment do you want at the end of your life? This deals mostly with life support measures such as CPR, feeding tubes, and breathing machines.
Doctors use life support when some part of your body can’t do what it normally does. It may ease pain or keep you alive until you start to heal. But in some cases, that same treatment may only lead to a slower death and a lower quality of life.
If you choose the option of refusing to have life saving measures performed (Do Not Resuscitate or DNR), you’ll still get medical care. Doctors will still manage your pain and give the other support that you need.
CPR: Doctors use CPR (“cardiopulmonary resuscitation” is the long name) if your heart or breathing stops. They may:
- Push on the chest with a lot of force again and again
- Blow air into the lungs
- Use electric shocks, called “defibrillation,” and drugs to start the heart
CPR works best when you’re in mostly good health and someone starts it right away. But if you’re very sick, it might not work. You could also be injured from so much force on the chest.
If you don’t want CPR and you’re in the hospital, your doctor needs to write a do-not-resuscitate order in your medical record. If you’re at home, some states allow doctors to write a “non-hospital order” so emergency workers know they are not to give you CPR.
Feeding tube: If you can’t eat or drink on your own, doctors may want to use a feeding tube to give you nutrients. In some cases, a feeding tube can save your life. It gives your body food and liquids while you get better. It’s also needed for some long-term illnesses.
Near the end of life, a feeding tube may be less helpful. It doesn’t cure or heal any illness. And it may even cause more problems than not eating at all.
Doctors and families may disagree about this, so it’s important that your loved ones know your wishes.
Breathing machine: A breathing machine called a ventilator pushes air into your lungs to help you breathe. You may need it in the short term until you can breathe on your own. In some cases, such as an injury to your spine, you might use it for much longer.
When you’re at the end of your life, though, a breathing machine may do little more than draw out dying. As with other life-support treatments, it gives you more time, but it’s not a cure.
Health Care Agents
While it’s important to think about what you want and make choices, you can’t plan for every possibility. And you may not be well enough to make decisions for yourself. This is why you may want to name a health care agent.
This is someone you choose ahead of time to make health care decisions for you. This person can be almost anyone: family, friend, lawyer, or someone in your faith group. You’ll want to be very clear with them about your wishes.
You may also want to consider whether you want to donate your organs. No matter how you choose, it’s best to let your loved ones know so they can support your decision.
If you’d like to donate, you can put yourself on your state’s organ donor registry. You can visit organdonor.gov to find out where to sign up.
How to Make Your Choices
End-of-life choices can be hard to make. Not only do you have to think about your own death, but there are medical and legal decisions that aren’t easy.
One way to make sense of what you really want is to talk about it. You can turn to your family and friends, doctors, or a lawyer. All can help in different ways.
Family and Friends: When you talk to your loved ones, getting started may be the hardest part. Here are a few ways to approach it:
- Bring up a related topic, like if you just made or updated your will.
- Share your values about a good life: what gives meaning to you, what your beliefs are, how you feel about dying.
- Tell them what got you thinking about it, such as an event, an article, or the death of someone close to you.
When and where to best discuss your wishes depends on you and your family. You may want to talk one-on-one or maybe with a small group. If you talk before you have an illness, it can help put you and your family at ease.
Doctors: When you see your doctor, you’re naturally focused on taking care of your health so you can live as long, and as well, as possible. But it’s never too early to ask your doctor questions about end-of-life choices. In fact, it can be easier to think through when you’re not dealing with a serious illness.
Your doctor can walk you through the pros and cons of the most common issues.
Lawyers: To make your wishes clear, you can use two different legal forms called “advance directives.” The first is a living will, which tells doctors what kind of care you want to get at the end of your life. The second is called a health care power of attorney, which names your health care agent. (This is a person or people who are able to speak for you if you lose capacity to speak for yourself. Also, it can be canceled or changed at any time.)
Laws about advance directives vary from state to state. If you split your time between states -- summers in one and winters in another, for instance -- then you do need to think about laws in both places.
When End-of-Life Wishes Aren’t Known
Sometimes, families need to make decisions for a loved one without a living will. They may have no idea what the dying person wants; for instance, if someone was in an accident or other emergency.
If you need to make these choices for someone close to you, you might try to put yourself in their place. What was important to them? What do you think they would want? How did they live, and what can this tell you?
Another idea is to try and think of the person’s best interests. If you give the go-ahead for a treatment, will they be in pain? What will their quality of life be like?
You can also talk to your family. If you can’t agree with each other, you may need to talk to a mediator. This is someone who helps people find common ground. You might also check with the hospital to see if they have someone who can help you decide as a group.
No matter how well people know you, your desires for how you’d like to die may not be clear. When you make choices ahead of time, put them in writing, and talk to your family, you can bring relief to yourself and the people who love you.