I’ve been listening to Radiolab podcasts for awhile, and today, The Bitter End came up.

In an unpleasant coincidence, a friend’s mother died over the weekend, so advanced directives were already in the front of my mind.

This is a subject I’ve written about a lot over the years, because end-of-life care is something most people tend to ignore until it’s in their faces and they can’t ignore it anymore.

First and foremost, I want to congratulate West Virginia University for putting advanced directives and medical power of attorney forms out as something to be discussed NOW. Hell, PEIA will give us a $4/month discount for having filled out and submitted these forms, because it really is that important.

These are decisions that need to be made while and discussed with your loved ones while you are young and healthy.

Yes, it’s a hard thing to do, but it’s IMPORTANT.

In the podcast they interviewed a doctor who said he tries to ask his patients who are over 50, “How do you want to die?”

Good on him, except it’s not a question that should wait until we are 50 or 60 or 70, it’s something to be considered when you’re still young, because even if you are unlikely to develop a debilitating disease, you can still be struck by a bus or an infectious disease that renders you incapable of making your own medical decisions.

We all like to think that our loved ones would know what our wishes would be, but time and again this has proved to be not so for so many families. You know the ones–you probably remember seeing some of the legal fights splashed across the evening news.

Make sure there is nothing to argue about–put what you want in writing, and make sure your doctor knows your wishes.

In West Virginia you can file these medical papers electronically. If you don’t have that option, make sure you tell your family where these papers are.

Put your wishes down in writing.

Talk to your family about what you want to happen and/or where your papers are filed.

Go back to that Radiolab link. See that chart? That’s asking doctors what treatment they would want if they were were to suffer “irreversible brain injury without terminal illness.” When the same questions were asked of lay people–just your average person walking down the street–most of those responses were the exact opposite.

Why? Because doctors know things lay-people don’t.

Take CPR.

As opposed to many medical myths, researchers have reliable data concerning the success rates of CPR (without the use of automatic defibrillators) in a variety of settings:

2% to 30% effectiveness when administered outside of the hospital
6% to 15% for hospitalized patients
Less than 5% for elderly victims with multiple medical problems

(emphasis mine) Surprised by those numbers?

How about this?

…risks of CPR include harmful side effects such as rib fracture and damage to internal organs; adverse clinical outcomes such as hypoxic brain damage; and other consequences for the patient such as increased physical disability. If the use of CPR is not successful in restarting the heart or breathing, and in restoring circulation, it may mean that the patient dies in an undignified and traumatic manner.

Think about that for a bit.

Is that how you want to die?

Once you’re done thinking, talk to your doctor about completing an advanced directive. Then discuss it when your family and friends.

Because these decisions and discussions really should not be put off.

See:
End-of-Life Care in the United States – August 17, 2009
At the End – May 1, 2008
End-of-Life Care – March 30, 2004
Related:
Death, Grief, and White Hot Rage