Tuesday, January 1, 2008

Ethics of Dying: Why me?

I give talks on various topics. One is the Ethics of Dying. One reason I was originally asked to speak on this topic is that I have made end of life decisions for both my grandmothers and my mother. I was with each of them when they died. Intellectually, I can tell you that I have absolutely no problems with the decisions I made in each case. Emotionally, these decisions still have the power to make me second-guess what I did. This is true, even though, I knew the wishes of each of my loved ones.

My maternal grandmother had seven children, but she chose me to make her end of life decisions. I think she understood that her children would never agree and that would create ill feelings. As the oldest grandchild, I knew the dynamics of the family and believe she made the correct choice. One of my aunts did not agree with my choices, but she knew I followed her mother's wishes and did not object. She would have opted for keeping her mother alive by any means as long as possible.

That is my message today. You must communicate with your loved ones. If someone is legally empowered to make these decisions for you, they must know your wishes. If you are to make these decisions for someone else, ask them what they want. This does not mean a simple: "let me die." Modern science can provide a host of options as death nears. Some involve the use of machinery to keep you alive. Do you want to be on a respirator? Think about that now while you are healthy and tell your loved ones. Better yet, put it in writing. A living will is one way to communicate your wishes.

The biggest decisions involve food and water or as I prefer to say: artificial nutrition and artificial hydration. This is a highly personal decision that I believe only the individual can make. I do know that deprived of artificial nutrition and artificial hydration, the body stops fighting and chemicals are released that ease the end. So if I am dying, I do not want artificial hydration or artifical nutrition. How can you expect someone to make these decisions if they have not discussed it with you?

Do you want hospice care? Deciding to use hospice, usually means ending the fight to stay alive. Comfort is the primary goal. Again, something to think about and discuss.

I have seen the decision to administer artificial nutrition and artificial made both ways. I have made it both ways for my loved ones depending on their wishes and the circumstances. I have second guessed myself either way, even though I know I honored their wishes. For this reason. I urge everyone to communicate their end of life desires.

I believe the best way to communicate is by executing the proper legal documents as designated by your state. Most hospitals can supply forms for this and you can always seek an attorney's advice. Other organizations such memorial and burial societies ( http://www.funerals.org) can provide assistance. Just realize that some of these documents are specific to each state. Use those designed for where you live. If you later move, they will be honored, but it is always better to execute those specific to your home state. If nothing else, put your wishes in writing in your own words.

1 comment:

Bailey said...

Hello -
I just read your article about end-of-life deicsions. Thank you.
I wanted to let you know I am a documentary maker and hospice volunteer in Atlanta, Georgia.
I've produced a short documentary about end-of- life decision making, palliative care, caregiving and hospice.

It's called 203 Days.
You can view it in its entirety at the following University of Connecticut website along with a study guide.

It is an unflinching look at the day-to-day interactions between patient and caregiver, in this case an 89 year old woman who is living with her daughter.


203 Days just won the First Place 2007 Film Award from the National Hospice and Palliative Care Organization (NHPCO).

If you'd like more information please go to my website

I hope this film is helpful to people who want to know more about some of the most common experiences for caregiver and patient at this difficult time.

Bailey Barash