Honoring Death: Advance Directives

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Doing The Documents and Doing The Tao

If there is a punishing place where we pay for all the sins we’ve committed in this life, as Danté so vividly describes, then I will be confined in a room, a cold room, filled with medical and legal documents to complete and submit – to someone.  And if this place exists then, I bet, there will be many souls confined in adjacent rooms.  And it would answer the question as to why so many of us do not complete the necessary documents that may increase the odds that we will receive the kind of medical care we would prefer when we can’t speak for ourselves.  Yes, I’m talking about Advance Directives: Health Care Proxy and Living Wills. 

As cynical as I may sound, I whole heartedly encourage everyone to do this work.  But you have to be dauntless and determined depending on how much you want to try to direct.  Reflecting my cautious approach, I prefer to call my document “My Advance Hopes”.  I became cautious in my optimism during my years as a Registered Nurse, and witnessing the plights of passing friends.  Too many times Advance Directives had been completed but for one, or another reason, they did not accomplish the intentions of the ‘Director’.  I have come to believe that, unless I pin my Advance Hopes to my underwear, I cannot reasonably expect emergency &/or other medical personnel to know what I hope.  And if I re-gain the capacity to speak for myself and I find that I’ve been intubated and connected to a mechanical ventilator to breathe for me well… it’s time to Do The Tao.  Lean in to the experience,  and know that my time will come and that’s it’s getting closer.

Getting Started

The first Advance Hopes I drafted was a two-page ‘New York Living Will’, I don’t remember the source.  I did this when I first started my ‘One Year To Live’ experiment.  One year later those 2 pages have additional notes and scribbles and I went looking for another template.  There are a lot of resources, some better than others.  I looked at the information on one sight and was Overwhelmed!  But, it does provide a lot of info.  I suggest that you go to your State’s Dept. of Health Website where you will find all the info you need.  Additional resources on our Resources Page.  Find the ‘form’ most suitable and fill it out!  Then: “KEEP THIS SIGNED ORIGINAL WITH YOUR PERSONAL PAPERS AT HOME. GIVE COPIES TO: FAMILY, DOCTORS, LAWYERS, AND OTHERS WHO MIGHT BE INVOLVED IN YOUR CARE.”

I Need To Do What?

No, it’s not finished yet and it can get quite tricky if one is admitted to a ‘medical facility’ – hospital, rehab center, nursing home – because there’s a form for this as well.   Most States have implemented the use of “POLST” or “MOLST” forms. : Physician or Medical Orders for Life-Sustaining Treatment.  NYS uses the ‘MOLST’. The intention is to have One Form be accessible to medical professionals whether at a hospital, nursing home, or as the EMT’s crash into the home because someone has stopped breathing and someone else called 911 five minutes later.  The paper MOLST form is iridescent pink, file-folder heavy.  There is an electronic (eMOLST) form that may be available and which would attach as a permanent part of one’s medical record.  it is not yet perfected.

The point about the MOLST is that it becomes a Medical Order, signed by a physician and it addresses the key treatment issues which is critical in the Medical Domain.

  • Cardio-Pulmonary Resuscitation   or Do Not Resuscitate
  • Name of Health Care Proxy and “if there is no health care proxy, another person will decide, chosen from a list based on [NYS’ law.”
  • Intubation and Mechanical Ventilation (placing a tube down the throat and connect to a breathing machine – no eating or drinking).
  • Artificially Administered Fluids and Nutrition (insertion of a feeding tube)
  • Antibiotics
  • Management of Pain
  • and Future Hospitalization – whether one is at home or in a nursing facility
  • P.S.  all medical care facilities should have MOLST (or POLST) forms available and ready to be implemented.  This is by no means a complete list of life-prolonging interventions one may need to consider, eg. dialysis, transfusions.

Now Who Wouldn’t Want To Get This Done ASAP?                                                                 We're Dead

There is no morbid-ness about it.  The First Thing that I don’t want to have to think about when I’m face to face with my buddy, Death, is whether someone is going to crack my ribs to get my heart started again, or stick a tube down my throat and delegate my breathing to a machine.  From Dr. Sherwin B. Nuland author of How We Die:

“The final disease that nature inflicts on us will determine the atmosphere in which we take our leave of life, but our choices should be allowed, insofar as possible, to be the decisive factor in the manner of our going.”

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