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An 82-Year-Old Woman Explains Why She Has a Living Will

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By Ingrid Komar
Special to The Washington Post
Tuesday, September 1, 2009

I am 82 years old, have had a wonderful life and, although there are things I would still like to accomplish, I am not interested in merely extending my life via a much-diminished existence. As a result of smoking for many years, I have chronic obstructive pulmonary disease, or COPD. It is a debilitating disease. I can't walk very far without getting out of breath.

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And I have a living will.

My disease is not curable, and it's only going to get worse, so several decades ago I drew up a document specifying exactly what medical care I do, and do not, want in my final days.

Opponents of health-care reform have tried to scare people into believing that the government, by encouraging doctors to talk to their patients about living wills and end-of-life care, will decide who lives and who dies. But the bad news is not that the government will make these decisions for you. The bad news is that you will have to make them yourself, and then make your wishes known to the appropriate physicians and medical facilities.

I characterize this as "bad news" partly in jest, but I can tell you from my experience in putting together my own living will that it is hard to make yourself think about all the possibilities that might occur as your life is winding down and how you want them handled.

The good news is that counseling about end-of-life care would be covered for the first time by Medicare under health-care legislation being considered by Congress. Medical professionals you choose would provide advice and guidance; you would be free to follow or to ignore it -- or not consult them at all.

The issue most commonly addressed in living wills is whether you want to be kept alive via breathing and feeding tubes if there is no reasonable expectation of your recovery. But there are more subtle issues. For example, in my living will, I direct that if I have a terminal illness diagnosed, "no matter what my condition, my health care provider(s) [shall] administer such medications and perform such medical procedures necessary to alleviate pain and provide comfort care, even if such medications and/or procedures may hasten the moment of death."

This and similar clauses are necessary to protect your doctor against lawsuits and to relieve him or her of the obligation to keep your life going at all costs. High doses of morphine to lessen pain may hasten death in some terminal patients. I don't want a doctor so focused on keeping me alive that he or she might limit the strength of pain-reliever dosages, resulting in needless pain and potentially considerable expenses as well as possible emotional distress for family and friends watching me suffer.

The proposed health reform legislation would provide reimbursement for seniors to review their living wills every five years, which seems sensible.

Based on experiences during my last hospitalization for COPD, I revised my living in 2004 to specify that I do not want to be treated with a breathing tube, should I have another crisis. In research I did on intubation, I learned that inserting a breathing tube is a difficult and traumatic procedure from which I would anticipate a long and difficult recovery that at best would leave me even more incapacitated than I am now. For me, it isn't worth it. Someone else in my condition might well make a different choice, but this is the choice I have put in my living will for my doctors and family to follow.

My sons were supportive of my living-will directives; far from pushing them, my doctor acknowledged them with slight reluctance. It is possible that when you ask your family to collaborate in the drafting of your advance directives, they will say, "We don't want to think about that!" But the time to think about these matters is precisely when things are pretty normal, when cookouts are the biggest item on the family agenda. It is in a calm atmosphere devoid of the distortions inevitably caused by a medical emergency that you and your family can best make big decisions that will affect all of you.

I hired a lawyer when I first drew up my living will (and an accompanying medical power of attorney, which specifically designates who will make decisions on my behalf if I become incapacitated). These days numerous listings on the Internet offer free guides and forms to help folks with this project avoid incurring legal expenses.

Executing a living will not only ensures that your last days on this earth will be as close to what you would wish them to be. It is also a measure of the consideration you have for your family and friends. Planning for the end of life does not lessen the sorrow family and friends feel when a loved one dies. But I do believe it enhances their ability to make peace with their loss and to move toward acceptance.

We all have to die someday. But unlike billions of people who lived before us, we have a few choices regarding our final days. Why would we not exercise them?

Ingrid Komar is retired and a resident of Washington. Comments: health@washpost.com.


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