Tag Archives: New York Times

How to make farewell conversations more meaningful

Spending time with family over the holiday season can be a joyful reminder of just how much we cherish our conversations with loved ones. Whether it is sharing a meal with a sibling who lives in another city or enjoying quality time with a parent, we all seek these often fleeting opportunities to express ourselves to a loved one in a meaningful way.

What we can take for granted though, is that there will come a time when the ability to connect with family members is taken away from us without warning. That is why many experts tell us to have these important conversations while we are still able.

Bruce Feiler confronted this issue in a recent article in the New York Times entitled, “Exit Lines.”

Feiler writes,

Shelly Kagan, a philosopher at Yale and the author of ‘Death,’ said the odds are so ‘vanishingly small’ that you’ll know when you’re in a final conversation, you should avoid any possibility of regret by initiating interactions earlier. This includes what kind of medical interventions the person might want as well as what that person meant to you…

‘One of the things you can accomplish in these conversations is telling people broadly what it is they’ve done for you. What they taught you. Having an appreciation of that can deepen one’s sense of a life well-lived…’

When his own mother died, Dr. Kagan said, she was not in a position to have a conversation at the end. Later, her children found a letter she had written to them, along with one to her grandchildren, expressing her hopes for their lives. It was her way of having a meaningful conversation while her mind was still strong, Dr. Kagan said…

Dr. Kagan said there is considerable evidence that forcing ourselves to say things out loud helps us clarify thoughts that might otherwise be unformed. ‘It’s a richer experience when the receiving party is able to react,’ he said. ‘But even if they’re not, the vocalization can help in that you now have thoughts you wouldn’t have had anyway.’

People who have lost loved ones suddenly can attest to the power of that ‘final conversation,’ especially when faced with the despair of missing the chance to have that conversation.

Being proactive about recording a message either in writing or on video is significant because it allows you the security of knowing your voice will be heard. And maybe even more importantly, it ensures that your loved ones will never be in the helpless position of not knowing how you really felt.

MyDirectives continues to encourage individuals to record video messages because that is the most effective way of knowing that your voice will be heard if you are no longer able to communicate.

Have you taken steps to leave a message for your loved ones or have you received a message from a friend or family member? Share your story using the comments below, on Facebook or on Twitter.

Letters about the Difficult Decisions at the End of Life

The letters to the editor in response to the editorial, “Care at the End of Life,”  published by the New York Times on November 24, highlight the increased attention being given to the need to enable individuals to declare end-of-life decisions in advance.

In one letter, Carolyn Conley, a registered nurse with years of experience treating cancer patients, outlined two main advantages for advance directives:

First, it makes it less likely that patients will have unnecessary, unwanted and possibly uncomfortable tests; second, it lifts the burden of medical decision-making from families during a very stressful period, allowing them to spend meaningful time with their loved ones without the additional stress of having to make these difficult choices.

In a second letter, Adina Kay-Gross, who recently lost her father to metastatic lung cancer, wrote of the experience:

Because he was allowed to call the shots, because, when given all the information, he alone chose the circumstances of his death, the end of his life was as loving, as dignified and as human as he was.

We are so grateful that my dad was spared the suffering that no one should have to endure unwillingly.

In today’s world, with a growing number of Americans caring for aging parents, the increased attention to advance care planning is welcome.

But should the focus on advance directives be aimed only at elderly and terminally ill patients?

Interestingly, neither the editorial nor any of the letters to the editor mention the notion of documenting medical wishes earlier in life. After all, no one waits until they’re terminally ill to buy life insurance, or until they’re on their deathbed to think about organ donation.

It’s time to take advance care planning one step further. We should not only be encouraged to decide matters of medical care at the end of our lives, when it may be impossible to communicate our wishes. We should take action to make these tough decisions as we enter adulthood, so that our voices are preserved in all medical situations.

Share your thoughts and join the conversation on Facebook and Twitter.

New York Times on Care at the End of Life

Over the weekend, we were encouraged to open our copy of Sunday’s New York Times to read this in an editorial, “Care at the End of Life,” about end-of-life decisions and planning:

Three years ago, at the height of the debate over health care reform, there was an uproar over a voluntary provision that encouraged doctors to discuss with Medicare patients the kinds of treatments they would want as they neared the end of life. That thoughtful provision was left out of the final bill after right-wing commentators and Republican politicians denounced it falsely as a step toward euthanasia and “death panels.”

Fortunately, advance planning for end-of-life decisions has been going on for years and is continuing to spread despite the demagogy on the issue in 2009. There is good evidence that, done properly, it can greatly increase the likelihood that patients will get the care they really want. And, as a secondary benefit, their choices may help reduce the cost of health care as well.

… No matter what the death-panel fearmongers say, end-of-life conversations and medical orders detailing what care to provide increase the confidence of patients that they will get the care they really want. In some cases, that could well mean the request to be spared costly tests, procedures and heroic measures that provide no real medical benefit.

But while we’re happy to see the New York Times tackling advance care planning, we think advance planning isn’t just for the end of life. It’s also for medical crises – for the 20-year-old on her way back to college after a break who is in a car accident or for the 35-year-old who collapses suddenly while out jogging.

Healthcare emergencies can arise at any time in your life, and some, while not life threatening, may prevent you from expressing your wishes. Less than a third of Americans currently have an advance directive. As a result, millions of Americans arrive at these most vulnerable moments of their lives unable to face them in the manner of their choosing.

Have you completed your advance medical directive? If not, what’s keeping you from laying out your plan? Share your thoughts with us in the comment section below, on Facebook or on Twitter.

How to Live.

From the TV shows we’ve been watching to Monday’s New York Times op-ed by Bill Keller, it’s clear that something is going on. Something big. Something powerful. 10,000 baby boomers A DAY are turning 65. We’ve gone from the
“sandwich generation” term to the new phrase: the “club sandwich” because we’re taking care of kids, siblings, parents, aunts/uncles, and some grandparents. So, perhaps it’s time to have a conversation about how we want to live. Shift the focus. Empower ourselves to be a part of our future – whatever that may be.

In Monday’s op-ed, Keller writes eloquently about the end of his father-in-law’s life before exploring the differences between a health care system that allowed his father-in-law peace at the end of his life and our own in the United States:

When they told my father-in-law the hospital had done all it could, that was not, in the strictest sense, true. There was nothing the doctors could do about the large, inoperable tumor colonizing his insides. But they could have maintained his failing kidneys by putting him on dialysis. They could have continued pumping insulin to control his diabetes. He wore a pacemaker that kept his heart beating regardless of what else was happening to him, so with aggressive treatment theycould— and many hospitals would — have sustained a kind of life for a while.

But the hospital that treated him offers a protocol called the Liverpool Care Pathway for the Dying Patient, which was conceived in the 90s at a Liverpool cancer facility as a more humane alternative to the frantic end-of-life assault of desperate measures. “The Hippocratic oath just drives clinicians toward constantly treating the patient, right until the moment they die,” said Sir Thomas Hughes-Hallett, who was until recently the chief executive of the center where the protocol was designed. English doctors, he said, tell a joke about this imperative: “Why in Ireland do they put screws in coffins? To keep the doctors out.”

Keller asked an end-of-life specialist in the United States about the chances of something like his father-in-law’s experience happening here. The specialist said: “Zero.”

Keller explores why that might be, delving into the political controversy that arose a couple years ago over the so-called “death panels.” Here’s what we think though: dying in the U.S. doesn’t have to be that different from the Liverpool process.

We too can know the peace that Keller’s father-in-law did when he told his daughter: “I have fought death for so long. It is such a relief to give up.”

While we may not have a special protocol like the Liverpool Care Pathway for the Dying Patient, we do have advance medical directives, which not only allow you to make your own healthcare decisions in case you’re in a situation where you can’t speak for yourself, but also prepare you for the end of life. Directives are a document too many of us avoid. And the conversation about them with our family and friends is something some prefer to not do, but planning ahead and starting the conversation now is too important to not do.

Need help starting the conversation? Check out our conversation starters.

Have you had the conversation? Share what you learned and provide tips for others still trying to have the conversation.

Crossposted from MyDirectives.com