End-of-Life Decisions I do not want my life to be prolonged if:
• I have a terminal condition
• I am permanently unconscious, or
• the likely risks and burdens of treatment would outweigh the expected benefits.
In accordance with these wishes, I do not want artificially administered food and water.
Grant of Discretion to Agent
If I have expressed, in this document or in any other manner, a clear wish regarding a specific treatment or condition, I want that wish to be followed. In all other situations, I direct that my life not be prolonged and that life-prolonging treatment not be provided or continued, in accordance with what my agent determines to be in my best interest. In determining my best interest, my agent shall weigh the burdens of treatment against the expected benefits, considering my personal values to the extent known to my agent.
Relief From Pain
I direct that treatment for alleviation of pain or discomfort be provided at all times, even if it hastens my death, except as follows:
When the time remaining to me in this life is short by any reasonable definition, I will trade a few moments of lucidity for relief from agony. I have no more "last words" to communicate. Whatever secrets I take with me stay with me. I anticipate no deathbed changes in firmly held principles. There will be no last-minute religious conversions. I have not been reticent in expressing my love or in extending forgiveness. As death approaches, I direct that treatment for alleviation of pain or discomfort be provided at all times, even if it hastens my death or makes it impossible for me to communicate. Those I love know that already, and that is the only message worth expressing. Play my favorite music, if you can find it. If not, Bethoven will do.
Other Wishes
In addition to the instructions I have given above, I would also like my health care providers and others involved in my care to follow the instructions below.
Personal Values Regarding End-of-Life Decisions
I have read authors who profess horrible fears that death will mean the extingushing of their existence. I don't know what is on the other side of that door, but I certainly do not feel so self-important that I fear my end. Many people seem genuinely afraid to die. Do they fear eternal punishment? I do not. Is it an instinct, the last gasp of self-preservation? It is the job of our minds to calm our instincts.
I understand that many of the special skills I have developed in my life will not survive me. I wish that I had been granted a better opportunity to know my grandchildren and pass along what I could. But no one really has the opportunity to see his hard-won skills live on after him. Everyone takes anything that is meaningful in life with him to the grave. New generations start over and learn again, That is simply the way it is. Who am I to question the sequence?
My soul feels a deep calm. I have spent enough time among the living, the dying and the dead to appreciate the nature of the process. I have also witnessed birth and the development of children to adulthood. This is how life proceeds. I understand the importance of sex to the survival of a species. I also know that sex would be meaningless without death and birth. I appreciate the wonder of the universe and especially the wonders that are beyond my ability to understand. My mouth gapes like a child taking in his first Christmas tree. I have been given many opportunities and I have done what I have done, most for better, some for worse. I have taken my turn with my shoulder to the wheel, pushing civilization along the best I knew how. I took over the task from my father and he from his. My children are now taking my place and my grandchildren are learning that being a grownup is their lot as well.
How can you understand the pattern in this and fear death? Do you see yourself outside of history? You are deluded. So, to repeat myself, I do not fear death. The death of an individual marks the end of one cycle in the pattern, that is all. Those who will live the next cycle have been born and are getting ready to shuffle their genetic inheritance and reproduce, creating unique individuals who may be slightly better adapted to this environment than we were. But only slightly.
I am grateful that I have been given the opportunity to play a nearly insignificant part in the great show that is the rolling wave of humanity. I have enjoyed it, mostly. I have tasted success and defeat, advantage and it's lack, sorrow, joy, love and hate, true ecstacy, deep depression, happiness, contentment. I have been largely spared pain and infirmity although that may lie in wait around the corner. I understand that the cycle for one individual ends when it ends. There is little to gain from shifting the timer a little either way. I do not think I am writing the great literary work that I must stay alive to finish.
So let me end in peace, let me end in peace like a silent snowy meadow in the mountains with a full moon glinting off each snowflake. Let me end in beauty like the calm ocean with a full moon making the whole world like silvery metal with just enough disturbance to let you know it is not solid. Well, that's my hope, lets see what I get. If it's reasonably fast it doesn't much matter. If it is horribly drawn out part of me will be inside crying. But I understand some pain is unavoidable. I also understand that we do not completely chose the future, it unrolls in front of us.
I have enjoyed the ability to spell words in English correctly. I would have corrected each spelling mistake in this document if the software were not so balky and my patience short. Where I've made a mistake, I know it. Please forgive me.
Wishes Regarding Hospice and Palliative Care
I am not afraid to die. I am quite reasonably afraid of being tortured along the way. I value my lucid concious mind. This is the essence of life to me. I have witnessed others take general leave of their wits. I have seen people susutained in this condition for years and find it morbid and grotesque. Sustaining the body when the conscious mind no longer functions is a supreme exercise in false hope or indecision. Keeping the shell of the body technically alive is no virtue once it's owner no longer spends any appreciable time in residence. It constitutes an immoral allocation of social resources masquerading as waiting for God's will to be manufest in ending the person's life. We are God's agents and must be the conservators of his creation and the liberators of the unconscious suffering.
Although it is possible for the demented to occasionally stitch together a few moments of lucidity, it has never seemed to me that such flashes of consciousness outweigh the horror, for them, of realizing they will sink back into confusion and incommunicability. Existence, for the demented, must seem like a horrible dream. They still feel pain and frustration. Please do not sustain my body for one more brief flash of some remnant of what had been my mind. Let me go to my natural and inevitable end as has every predicessor from time immemorial.
The law may not recognize profound dementia as an immediately terminal condition. I consider it to be the death of the person while the body is still walking around. The demented are essentially warehoused, waiting for their bodies to achieve the same state their minds already have. If they were not supervised as closely as small children, the profoundly demented would die from an inability to eat and drink by themselves or they would wander into dangerous situations and be lost.
If my mind slowly fails before my body does, I would like to continue my normal activities as much as possible. You may take away the car keys and anything else that might endanger others, but please don't take away my ability to walk outside or sail my boat upon the ocean. Such activity will sustain what is left of my spirit. The small risk that I may come to harm along the way is one I chose to accept.
I was not allowed to see my Grandmother for several years before she died. She was kept in a locked ward for the demented. My Grandfather visited her every day his own health permitted. She could not recognize him. What was the point of this? Was it to upset my Grandfather? Was it to protect my grandmother so even God would have to bide his time until her body failed enough to let him take her home? It seems that it was an inability of our social institutions to deal compassionatly with the issue of dementia. Was it the medical mantra of "keep the body going at all costs?" I do not know, but I think it was horrible for her and for those of us who witnessed this and are forced to remember her that way.
If my agent determines that I am on a reasonably certain and inevitable path to death I direct that I receive palliative care to keep me comfortable and alleviate pain. I do not wish to undergo "last chance" or experimental medical treatments that do not have at least a 25% chance of significantly improving my condition. I have never bet long odds and do not want to start now. Let medical science advance by torturing someone else. I have seen the effect of pain medications prescribed insufficient in either type or quantity and the prospect of this happening to me is horrifying. Addiction has no meaning for the terminally ill. Please use whatever must be used to be effective, whether that includes powerful opiates which will temporarily addict me to them or not. I shall soon be free of the addiction and your consciences may rest easy for you will have done me a final service.