Thoughts about End-of-Life

As of Early 2014

Few things brings one’s own mortality to the foreground than watching a loved one leave.

It is full of difficult decisions and tradeoffs. Although I fantasize that my thinking will always be clear as I age, it is simply unrealistic to expect so; and wishful thinking does not constitute a plan. In reality, my cognitive skills will likely decline with age. I expect that the decline will be (or has been!) imperceptible to myself. That is, I will be under the illusion that my mind is as sharp as it has always been, and perhaps even “wiser by experience” as I age, when in reality my thinking may already have deteriorated significantly. Without objective measures it would be tough to convince myself of the deterioration; and at some point, even with objective measures, it is possible that no amount of evidence could. As I like to say, trust is hard to come by; hell, I don’t even trust myself (well, my future self).

So in theory, a living will/advance health care directive should work. However, it is important for me that my wishes not be contradicted or overturned by my future self in a possibly compromised state. To me in my current, fully rational and informed state (yes, wishful thinking), it is far more important to me that instructions be followed as I direct them now, and not what I might otherwise instruct in a state of distress or panic. I want to be remembered as I currently am now, and not who I hope I will not become towards the end. For example, I do not know if I might, in a state of despair and/or diminished thinking, say, turn to a religion (monotheistic or otherwise), superstitious thinking, magical thinking, or unproven forms of folk/alternative medicine. It is a tough call and probably unusual, but I would like to explicitly state here that any changes made to my advance health directives after I become seriously ill and/or impaired should be ignored. If that is not legally possible or if it is overridden for any reason, I would like my original, unmodified directives to be made available to those whom I care about or those who care about me. It may sound silly since I would be dead or impaired and shouldn’t matter to me; however it is important to me now that those who remember me do so with the right perspective.

I also want to be fully informed of my medical condition, no matter how bad it is. If I cannot express my wishes, the default is to go hospice if there is no reasonable chance of recovery. No heroic efforts, no hail marys, especially if the treatment is experimental or scientifically unproven in nature, and/or may carry other risks or discomforts. I am not afraid of death. However, I am afraid that I will not be able to plan out the remaining time I have left. I want to see the end of the road, whether long or short, and if there are monsters on the way, so be it. If I show signs of depression, hallucination, or other types of mental problems, I want my caregivers to give whatever medication is necessary and respect my directives made before my mental problems have occurred. Only in the case where serious mental deterioration has occurred, and informing me fully of my medical condition would seriously adversely affect my wellbeing (such as suicide) do I waive the right to be fully informed.

I set up an account on MyDirectives.com, as it is a bit more comprehensive than ordinary living wills. Five Wishes is an interesting version but a bit too spiritual for me – I would have to cross out a lot. What also irritates me is the fact that the Five Wishes version seems more for the living than for the person facing death. Perhaps that’s what makes more sense, but somehow it still rubs me the wrong way.

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