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Episode 534 Advanced Directive
This is Retirement Talk. I'm Del Lowery.
"That's a pretty morbid topic,' my wife said in response to her question about a subject for this podcast. "Not as morbid as not having the conversation," was my response. One thing we all know for certain is that we are going to die. When ever people are asked how they want to die most say, "quickly and painlessly." That makes sense to me. The problem is we don't exactly know how we are going to die and many of the ways are the not quick nor painless. They are long and painful.
There are steps that can be taken to confront this predicament and in this podcast I want to talk about one that goes by the name of "Advanced Directive". It is a formal statement that is construct while we are healthy concerning medical measures to be avoided as we near death. If we have a medical directive we might want to review it and if we don't have one we might want to rush right out and get one.
We have all heard of CPR, ventilating or respiratory machines, intravenous feeding or hydration tubes, kidney dialysis, major surgery, antibiotics, pain medication and brain dead. When we are young and tough they may carry a different weight than when we are retired and nearing the end of an average life span.
Most of us are familiar with these methods or machines through the magic of television. Thus we have an incredibly inaccurate view of the results of using them. Doctors who deal with death as a matter of profession have a much different view. I happened to hear a podcast of RadioLab on this subject just recently and I feel like it needs to be shared. Of course you are free to look up and listen to the podcast yourself but I feel like I must pass on a bit of the information presented.
Back in the 1940s medical doctor students at John Hopkins University were asked if they would participate in a life long health study that might gain important significance over time. Throughout the years over 1300 students signed up and they are now nearing the end of the normal life span. Recently they were asked their opinions concerning using all of those measures I mentioned in the opening of this podcast: CPR, ventilators, kidney dialysis, hydration and feeding tubes, etc. Approximately 90% of them rejected them all with the exception of pain medication.
When folks on the street were consulted - folks like you and me - the numbers were reversed: 90% wanted them all. Of course they also wanted a quick and painless death. The difference is amazing. Those that have a limited view of death - regular folks like most of us - have a view that is the opposite of those doctors who deal with death as part of their profession; those that have witnessed many deaths. This is a sad state of affairs. People deserve better.
One example that was given concerned CPR. On television hands are placed on the chest and pressure is applied. People cheer and the victim soon response; life is restored and smiles all around. In real time 8% survive and of those 3% resume a meaningful life; 3% live in a chronic vegetative state, about 2% have a life but not a desirable one. They are not dead but they are very much a different person.
All of this doesn't sound good to me. Nor does it sound good to the doctors. That is why they resoundly reject all of these last minute attempts at extending life. This reality probably doesn't sound good to most of you.
I have a health directive in place but I pulled it out for another look. I want to make sure it is clear and in the right hands. I did have a talk with my daughter about this and I plan on having one with my son soon. Maybe I will just send them a copy of this podcast. My wife has been party to my thinking along these lines for years but the program did point out one more important step: sharing the information.
What complicates a difficult time for the ones making decisions at this critical moment in many lives is the arrival of your sister, your cousin, your child, or good friend who has not been informed of your wishes. The directive may be clear to your doctor, your wife and someone else but the one person who has not been privy to your wishes could make life very difficult for all.
It is important that a health directive be clear and be known to those who might be involved in your manner of death. It makes me think that I need to be a bit more active along this line. I don't want to cause tears, arguments, and hard feeling because someone is trying to carry out my own health directive. I don't think my death will leave everyone smiling but I don't want to make it more difficult than it needs to be.
One thing folks on the street and the doctors agreed upon was the preferred place of death. They all wanted to die at home
Considering the end of one's life is not a pleasant subject. But considering the little known information that is in direct opposition to reality is even more unpleasant. This is one place where it might pay off to plan ahead and be very pro active.
I highly recommend you pull up radiolab.org and listen to the show entitled "Shorts: The Bitter End".
This is Retirement Talk.
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