Deciding How to Die
When thinking about end-of-life issues like making a will or avoiding probate, also consider making a plan for how you want to die. While some deaths are quick and optionless, chances are good that you will be able to weigh in on many important decisions -- that is, if you have a plan, and if the people caring for you know about your wishes.
Your Options for Dying
You may not be able to control what causes your death, but you may be able to make a meaningful impact on your experience of dying. For example, if your death is at all foreseeable -- by a few hours or a few years -- you may be able to make decisions about:
- Where you die. Do you want to spend your final days in a hospital, at home, in nursing home, at your child’s home, or another location?
- Types of medical treatment to receive. Would you like to receive every medical option available to treat your illness? Are you open to experimental treatments? Or would you like treatments that focus on reducing your pain, rather than treating the cause of the illness?
- Prolonging your life or hastening your death. If death is near, do you want your life prolonged as long as possible? Or would you like to allow your body to die naturally, without intervention? Perhaps you would even like the option to hasten your own death if your quality of life has declined to the point at which you would no longer want to live.
- Pain control. Are there certain drugs you would not take, or other drugs that you definitely would choose to take if it were an option? If you had to choose between being lucid and being pain-free, which would you choose?
- Who will take care of you, medically and personally. Do you have a personal physician that your treating physicians should consult? Would you prefer to be cared for by a nurse at home? If it’s possible, is there a loved one who has offered to care for you at home?
- Who will make health care decisions on your behalf. If you can no longer make your wishes known, who should make medical decisions for you?
Chances are that your death will be foreseeable enough for you to be able to make some of these decisions, if you make a plan. (For a discussion about types of death and their likelihoods, see The Reality of Dying, by Bill Simmons of www.finalexodus.org.) If you do not leave instructions about how your death should proceed and if your condition keeps you from being able to make your own decisions, medical professionals and family members will likely decide many of these issues for you. Keep in mind that under the oaths of their professions, medical professionals must do everything they can to keep you alive, unless they have a clear (and legal) directive to do otherwise. Further, without planning, the court system may need to step in to make legal decisions for you -- like appointing someone to act on your behalf.
Planning and Documenting Your Wishes
The most accepted (and arguably, effective) way to plan and convey your wishes is to use a combination of health care directives -- most commonly, a living will and medical power of attorney. A living will allows you to document your wishes for health care and a medical power of attorney appoints a trusted person to make health care decisions for you, if you cannot make them yourself. Different states use slightly different names for these documents (and many combine these two documents into one), and the finalization requirements vary as well. But in every state, health care directives serve the same purpose -- to put your wishes in writing and to legally require your wishes to be followed.
As you make your documents, you will face many personal decisions. Thinking about the issues involved may be difficult, even if your choices are clear. If you have questions, consider consulting your doctor, lawyer, or spiritual advisor.
Here’s where to look for a health care directive:
- local senior centers
- local hospitals
- government websites (many states have their own “statutory” form)
- your state’s medical association, or
- online – many options, for example from Caring Connections or www.finalexodus.org.
You can also make a living will and health care power of attorney using Quicken WillMaker Plus. This software comes with a traditional will, durable power of attorney for finances, free access to Nolo’s online living trust, and many other useful forms.
Learn more about making Living Wills & Medical Powers of Attorney on Nolo.com.
Talking to Your Love Ones
Perhaps even more important than making your health care documents is talking to your loved ones about your wishes. You’ll want to talk to those who will be close to you at the end of your life, as well as those who may be called on to make decisions about your health care, living situation, or finances.
Having clear and direct conversations about your end-of-life wishes may be difficult, but doing so will help ensure that:
- Your agent understands your wishes. If you choose to make a durable power of attorney for health care, you will appoint an agent who will make medical decisions for you if you cannot make those decisions yourself. It’s vital that your agent understands your wishes because it is your agent’s job to convey those wishes to the people providing care to you. And while it’s a good idea to document your wishes in a living will, having a personal conversation with your agent will clarify what you want and also provide an opportunity for your agent to get a deeper understanding of your wishes. You don’t want your agent to have to rely on your living will for this understanding because there may be times when he or she needs to make choices without that document in hand.
- You will get the right care in an emergency. Sometimes, and often in an emergency, doctors don't have time to find, or even read, your living will. Instead they turn to the relative who is standing nearby to discuss the treatment options. This relative, whomever it might be, needs to understand your wishes. So to ensure that everyone who might end up in that situation understands your wishes, have real conversations with each of your family members.
- No one will be surprised by your choices. The time to head off controversy surrounding your end-of-life choices is long before the choices need to be made. Make sure that everyone who might be involved with this stage of your life -- spouses, adult children, physicians, or clergy -- understands your wishes. That way, when your choices are followed, there will be no question as to what you wanted. Have this conversation even if you make a power of attorney and a living will that explains your wishes. A personal conversation will go far to smooth over any concerns. And making sure that everyone is on the page will take some pressure off your agent, who will have the weighty job of making sure your wishes are followed.
If you’re having trouble talking to your loved ones about these issues, you’re not alone -- it’s not easy. Look for support in your community or online. For example, here are some resources suggested by Death Café, an organization that supports and promotes real and honest conversations about death. For more about talking with loved ones, read Conversations on www.finalexodus.org.