A Fun Look at Advance Directives

 

 

Heading towards a long overdue mammogram last week, I decided it was time to complete and TURN IN the ten-page Advance Directive that had been sitting in my OutBox for years.

“Turn in” being the operative phrase here, as I’d completed the form multiple times.

My first version, dated June, 2008 was piled beneath my latest version, dated November, 2016.  In between were a few other versions, none ready to go.  Was I being resistant?

 

Do you know what an advanced directive is?

I didn’t until I moved to Vermont.  I don’t know if they even have them in Virginia (where we lived between Kazakhstan and Vermont).  Maybe a reader can tell us below.

My doctor was the first to suggest it, giving me a blank copy back in 2007. Each time I’d be in her office, I’d get the question, “Have you filed your advance directive yet?”

Same with visits to the local hospital for whatever — x-rays, ER a few times, the standard every ten year exploration which shall remain nameless, etc. — I’d get the same query, “Do you have your advance directive with you today?”

I was getting tired of saying, “No; but I’m close” to everyone.

I’d heard it would be simple to fill out. If it were, I’d have had mine turned in eight years ago. And I wouldn’t still have had multiple versions of it, all with scribbles and cross-outs and the like, sitting on my desk.

The problem was, over the years, each time I went to fill it out I felt healthy; the sun was generally shining brightly outside my window. How was I supposed to decide just when I was going to want that feeding tube taken out? And did I even want it put in in the first place? How was I supposed to know now?

What I had to realize was that I needed to fill it out as though I’d be hit by that metaphorical 18-wheeler — tomorrow.

That helped.  I  dove into the Vermont Advance Directive for Health Care with gusto.

Right away, the title bothered me.

This was not a “Directive for Health Care.” This was a directive for death care. Yet finding the words “death” or “dying” in the 10-page document was a challenge.

We all know we don’t talk much about death or dying in this culture; I don’t need to remind you. But calling it a directive for “health care” seemed to go a bit far.  Still, I persevered.

And so shall we.

 

 

The first section asked, Who will speak for me if I’m unable?

This part was easy. Trusting that the 18-wheeler scenario was not in my future, I tapped my younger son, who is married to a nurse practitioner, as “alternate” (after my husband.)  My two sons can fight over her advice if they want, I figured. That’s fine. I’ll certainly not be involved, which is the point, isn’t it?  How nice, I thought.

 

Next came the sections dealing with whether (and how) I might want my life prolonged. Or not.

This part was harder. It has to do with feeding tubes, breathing machines, food, water, pain meds, antibiotics, and the like. It’s amazing what the medical world is able to do these days. The question quickly became, At what point do I want that DNR to start?  If ever.  (DNR stands for Do Not Resuscitate). 

It turns out “keeping me comfortable” in my final hours, days, weeks, is not so cut and dried. Some comforts would hasten my death and some would delay it.  I opted for the comfort, regardless of the consequences.

After reading,  Being Mortal (by Atul Gawande) a few years ago, I determined I was not going to go that “medicalization of old age” route he spoke so eloquently about.  It’s OK to die, when the time is right, I believe. The circle of life and all. I’m not afraid of it as far as I know.  For me, death will be another “great adventure,” another leap into that great unknown. I just hope I maintain that attitude as the years move on.

By the way, I recommend this book to anyone who believes they may die some day. I bought a copy and gave it to my son (the firstborn one; he’s supposed to share it with his brother).

 

The next section, asking about my Spiritual Needs, went relatively quickly.

 

Then we moved into the decisions to be made after death. Mostly, this half was about  what to do with the body. Here’s where the fun started for me.

 

Jerry Seinfeld once said, “We don’t understand death. And the proof of this is that we give dead people a pillow.”

For me growing up, the only choice was “open casket or closed?”  When people died, they were on display for a time, then they were buried.  Cremation became more common as I grew older. But even these two basic choices involve more decisions.

What to do with the ashes (save, spread, or bury)?
Where to put the casket or the urn (vault, mausoleum, or plot)?
A green burial or traditional?
Bequeath the body to a medical facility for study, or not?

And then there’s organ donation (an easy one for me; just look at my driver’s license).

 

 

 

Much as I love to compare cultures, there’s no need to reference those old Viking burials at sea nor the Tibetan and Mongolian “sky burials,” interesting as they are.   Right here in the USA, I found quite enough material to round out this post.

Do you know the other choices now available? I found three.

  1. Cryonics isn’t so new.  The American Cryonics Society (the only one without a website, though its Wiki page is pretty complete) was incorporated in 1969, making it the oldest. It and The Cryonics Institute, among others, provide “cryonic suspension” in liquid nitrogen until such time as a cure for your ailment (including “old age”) is found. Ironically (to me) participants in this program pay for its continuation through the purchase of a life insurance policy.
  2. Compaction is an option in what is the growing field of “green burials.” One can now opt to be compacted into a ball that is then attached to an underwater reef. Eternal Reefs.com is one such — honest; I’m not getting paid — Treehugger.com offers another. In South Korea, where burial space is at a premium, it is now possible to have your loved one compacted into a set of colorful beads, and displayed in the home.  It turns out this option is available here in the US as “cremation diamonds.” There’s a great NPR story on this; just click.

    Starting at $3499, this colorless cremation diamond from CremationSolutions.com  comes in four sizes.

  3. Space, the last frontier.  One final addition to this list of options is to have your remains launched into space.  I found two companies, Celestis and Elysium that provide this service. Turns out quite a few folks have already opted for this one.

 

The final section of the packet called for my wishes regarding what kind of memorial service/funeral I want.  

 

 

Here’s another that brought a smile. 

 

Planning for your funeral

My plans? I’ve set them out in a letter to my sons buried within my computer and added the password in the AD. You’ll just have to come up to Vermont (or wherever I wind up) when the time comes and see what I’ve planned.

Death and taxes, the long-standing duo that we are guaranteed to experience.  My Advance Directive was ten pages long.  How long was your last income tax form?  Yes; an Advance Directive winds up being a good deal easier to fill out after all.

 

 

How about you? What’s been keeping you from filing your Advance Directive? 

[NOTE: all comics in this post were taken from Pinterest with no further affiliation]

 

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  1. Interesting that Vermont is trying to get people to do something. In the UK there is much resistance to writing a will, let alone thinking about setting up Powers or Attorney (who makes decisions after you are no longer able) although that has had some bad press recently with relatives or friends stealing the assets instead of caring for the older person’s needs. I’m pretty sure most avoid thinking about how they want to go.
    I’m all in favour of cheap and cheerful for getting rid of me so a cardboard box and cremation will do fine. I’ve picked out some music and set aside money to pay for a party for anyone who wants to come to the wake.

  2. Thanks for the detailed descriptions, Janet! It’s another reminder that my husband and I need to re-do our wills and something like this. None of my doctors has ever mentioned an advance directive to me.
    My sister has a provision in her will that provides a sum of money to whoever takes care of her pets. I thought that was a good idea.
    Merril Smith recently posted…Songs of UsMy Profile

  3. It has been a long time since anyone mentioned this. What upsets me is even if you have one and the info on your drivers license it doesn’t seem to matter much. My mom had a DNR and they resucitated her around 9 times while she spent 30 days in the hospital. Big bucks. When my friend died she wanted to donate her organs and had it on her drivers license but they askd her husband (I was there) and he said “no” and that was that.

    • Yup. There are no guarantees. This AD is “merely” a legal document meant to guide your next of kin (or whomever you designate) to know your wishes. There’s nothing that guarantees they’ll follow those wishes. Reminds me of the old puppet string metaphor. Hmmmm, another post brewing. Thanks Susan.

  4. Janet,
    Back around 1980, when Rose & I moved to the Shore, we had wills made and at the same time had durable powers of attorney and ADs with specific DNR instructions drawn up. It wasn’t long thereafter that medical facilities began asking for ADs. So, yes we have them in VA and have had them for many years. But then, you were living on Chincoteague — that can sometimes be akin to living in an a parallel universe. 🙂

  5. Here is a link to US Living Will Registry which has links to each state for forms, etc. This is a timely topic, Janet. Our attorney, who gives a homework list for in between meetings, insisted that we do ours. My doctor, who is involved with palliative care issues, asks every time I see her. I have had information on my desk for 2 years as I needed to change some things. Yesterday I went on line to start that process. I had the paperwork in hand when I saw your post!!

    http://uslivingwillregistry.com/formslist.shtm

  6. Thanks for delivering this important information in your trademark humorous way. (Love your cartoons!)Everyone should make their wishes known and written via AD but, I admit, it is too easy to put it off. Wayne and I had our wills and health proxies done last year after years of talking about it.

  7. Yes, Virginia, there are advanced directives here…I’ve had one for a long time now. I don’t wanna linger, hate the idea of pain, hope to just die in my sleep…suppose everybody wants that.
    I do need some younger friends, as I went over mine just last week and realized one of the folks I had named to make decisions—–was dead.

    • Hi Terry. Im sorry for the loss of what must have been a good friend, but you made me laugh with your comment. And yes indeed, I’m a big fan of having young friends. I’m glad you stopped in.

    • What a great website and idea, Laurie. Thank you for the link.

      As for the humor, I like to believe there’s nothing too serious we can’t find humor in it — eventually. Time and humor, the two greatest healers.

      Thanks for stopping.

  8. This is great, Janet! Love the cartoons. We’ve been saying we need to update ours. Thanks. And thanks to Susan Taylor for the link.

      • My pleasure. Hope you’ll be able to get those, but you may need to watch the scary one when Woody’s awake! Speaking of scary movies, our doctor asked me if I have a directive & said, “What if you have a heart attack or stroke?!” But he never asked my husb the same! They’re the same age – 70s – & I wonder if Denial had anything to do with the “oversight.” I have an old directive but husb has none. Thx to your reminder, it’s now on the agenda. I’ve decided to make an ash of myself & be buried in the cemetery of Gov. Chittenden (first gov of Vt, & my 5th great-grampa) in Williston, his hometown & where I was born. I think it’ll add a certain symmetry to my obit. And hope all the grandkids will visit occasionally for a picnic!

  9. Janet – I love your attitude toward death. I wish I shared it, as when I’m honest with myself, I have to concede that it terrifies me. Perhaps that explains my inclusion in the “put it off” club. Compounding the problem is that I, like you it seems, tend to put a little too much thought into these sorts of things, which ends up in a bit of a state of paralysis. I need to adopt the “if I were run over by a truck tomorrow” approach — so thanks for that! As for the arrangements, I rather like Carolyn’s “cheap and cheerful” approach, although it seems that death is such a racket here in the US that “cheap” is hardly an option, whichever way you choose to proceed. The thought of which makes me considerably less “cheerful,” lol . . .
    Tim Fearnside recently posted…My TotalityMy Profile

    • Hi Tim,

      I’ve been thinking about my “attitude toward death” since you posted. What I’ve come up with is that it’s not so much specific to death and how I feel about it (not particularly in favor of it, you know; I like my life) but it’s about my reckoning with attachments. Over the past twenty or so years I’ve adopted that Buddhist mantra that our suffering comes from our attachments, so when I’m afraid or sad or whatever, (i.e., suffering) I try to figure out just what it is I’m “attached” to and strive to let go. Learning to “Let Go” has gotten me out of a good many difficult situations these past two decades. Of course, this is very easy to write about; it’s hard to do it consistently, I assure you. But comes easier with practice, as does so much.

      That semi has been a very useful tool for me for a very long time. It started when I ran my first development office. We worked on the principle that if anyone were to be run over that by mystical truck, none of the rest of us would be in the dark as to what needed to be done. I’m glad it has now served you well as well.

      Thanks for checking in.

  10. Love your post as well as the comments here. I believe in planning ahead so my family left behind won’t have to worry about what to do. My guy and I finalized our trust/will/advanced directive. Creamation, spread the ashes at our favorite walking spot, have a dinner party at a GOOD restaurant. That’s our directive! Americans are strange- not talking about death as if that will make it go away. 😏
    Pamela recently posted…The TUNING FORKMy Profile