Talking about death makes most of us uncomfortable. To younger people it’s almost abstract it’s so far away, while older people may feel overwhelmed by its inevitable approach.
As seniors lose ground, they may fight harder to maintain it, obsessing over minutia in their will, for example, or micro-managing family relationships so their heirs will live harmoniously. A balanced plan can provide peace of mind, however, which may lead to a richer life in the time remaining.
With that in mind, the Reverend Cathlin Baker and the First Congregational Church of West Tisbury hosted a workshop on Saturday called Planning for a Graceful Exit. Led by Paddy Moore of West Tisbury, a church member, the four-hour session was designed to help people of all ages address end-of-life issues such as estate planning, medical decisions, and emotional accounting.
Ms. Moore ran the gathering crisply and sensitively. The two dozen attendees were absorbed by presentations that were informative and not too long. Two interactive elements — both designed to encourage communication — were included to keep people involved, and they did.
Nell Coogan, an attorney in her early thirties who is also the Island’s legislative liaison, prefaced her remarks by lamenting the absence of younger people at the workshop, people who may have to make decisions about aging parents sooner than they know. “We hate to talk about it,” she said, speaking about the end of a parent’s life. “Even siblings, who assume they’re on the same page about what their parents want.”
From the other perspective, it’s important for parents to make their wishes known. Too often they shy away in order not to burden the children, but often it burdens them more.
Ms. Coogan described three legal mechanisms that can help clarify things for both generations. Through a Health Care Proxy (HCP), a parent can designate an “agent” who is given the authority to make health care decisions for them when they are no longer able to do so.
Terre Young, another panelist, pointed out that anyone over the age of 18 should have a Health Care Proxy. If a 20-year-old is seriously injured in an accident, for example, a parent no longer has legal authority to make health care decisions for them.
To guide the agent designated by an HCP, Ms. Coogan recommended that people create a living will, in which they indicate which measures they want taken to extend their lives. A document called Five Wishes, which combines a health care proxy and the living will, is recognized in 42 states across the country, including Massachusetts.
Next to speak was Timothy Madigan, a vice president of the Martha’s Vineyard Financial Group. “Planning for death is easy,” Mr. Madigan said. “Planning for incapacity is much more complicated.” To help organize one’s assets, he suggested a revocable living trust, which spells out how one’s property is to be managed during life and distributed after death.
While describing a comprehensive array of services available at his bank, Mr. Madigan reiterated time and again the importance of planning ahead. “It’s never too late to start,” he said. “Even if you’re near the end, you can decide what goes where — to children, to charities, and so on.”
Michael Hoyt, a funeral director at Chapman Cole & Gleason, echoed the importance of planning when preparing for a funeral. “If you have a plan in mind for your own funeral, it’s a good idea to write it down,” he said. “It takes pressure off children who don’t have to wonder or guess what a parent would have wanted.”
In response to a question about cremation, Mr. Hoyt said that bodies are transported off-Island to a crematory in Plymouth. A wag in the audience asked if the Steamship Authority required a ticket for a corpse riding in a hearse.
Another place to turn in preparing for the end is Hospice. Ms. Young, executive director of Hospice of Martha’s Vineyard, said that most families wait too long before contacting Hospice, missing out on invaluable support by doing so. “To many people, Hospice means death, but it’s really about life: for the dying person, family, and caregivers, it is about how to make life better,” she said. “It’s about planning, sharing secrets, forgiving, receiving forgiveness, and helping families heal.”
Ms. Baker, a former Hospice chaplain, stressed the importance of communication and of taking care of unfinished personal business. “It’s important to share the stories of our lives, our values, which can be a gift to ourselves and our families,” she said. She also recommended thinking ahead, even for those who might not have too long to live, “to free yourself through planning to achieve your goals.”
The last speaker was Dr. Beth Donnelly, a primary care provider on the Island, whose occasional bluntness was tempered by humor and empathy. “Physicians and patients must come to terms with their inability to postpone death indefinitely,” she said. “There is an intrinsic value to action for the doctor, the family, and the patient.”
Dr. Donnelly said that there are times when it may be best to let nature take its course, even with the power of modern medicine at one’s disposal. “It’s hard to distinguish at the end of life between what we can do, and what we should do,” she said.
In a crisis, the patient may not be able to tell the doctor, objectively, what he or she wants. Choices become clearer if a patient has created an Advance Directive, in which a patient indicates the level of live-sustaining measures they want. Some people decide they don’t want to be kept alive if their quality of life is too compromised. In that case, they would opt for Do Not Resuscitate, and the physician would not intervene past a certain predetermined point.
“What does a good quality of life mean to you?” Dr. Donnelly said, adding that one’s goals may change over time, and an Advance Directive may need to be revised.
If not exactly “older,” the audience was definitely of a certain vintage, shall we say, and the topic of the day was hardly light and breezy. Yet the mood at the workshop was upbeat. For some, perhaps, it was comforting, empowering, to learn about specific tools they could apply to their lives. For others, it may have just been a relief to finally start talking about a touchy subject.
In closing remarks, Ms. Baker said, “We’ve begun a conversation today. I hope you all continue it with your spouses, family members, doctors, and professionals. May it shape your days, enrich your life, and bring you joy.”