End of life decisions


To the Editor:

As Khalil Gibran reminds us in The Prophet, “Life and death are one, even as the river and the sea are one.” But death is not often simple these days. Advancing medical technologies present difficult and complex questions and interventions. As welcome as these are when they enable us to return to at least some degree of health and well being, the technology can present challenging questions when we face terminal illness or severely debilitating conditions from which we cannot recover.

Many Americans do not want to consider death. It’s hard to think about, much less plan for. Doctors often feel compelled to treat patients, instead of simply provide for their comfort at the end of life. Within families there can be strong disagreements.

But let us take some time to consider: Do we want our lives prolonged when we are critically ill or injured or very old and frail, and we cannot recover? Do we envision and wish for a peaceful dying, uninterrupted by medical or surgical intervention that will not cure us?

I encourage everyone to consider these difficult questions and write a living will or other statement of your wishes about your care and share it with your family, your doctor, and the person you choose to make decisions for you if you are unable — a health care proxy.

There are many ways to think about these questions. (And your wishes and your choice of proxy may change as you get older.) You can go into detail, listing the interventions you want and don’t want, and under what conditions. Or you can make a simple statement, for example:

“If I am permanently unconscious or there is no reasonable expectation of my recovery from a seriously incapacitating illness or condition: I do not wish to be kept alive by artificial means; I request that I be given all care necessary to keep me comfortable and free of pain; and I direct that no life sustaining treatment, including food or water, be provided.”

Models and forms for living wills and health care proxies are available at Island Hospice offices and on the Internet. The proxy form is a legal document. The living will is not in Massachusetts.

Recently my sister, who was 86 and had advanced Parkinson’s disease, had a mild heart attack. She was taken to the hospital. With her husband and children by her side, she rejected treatment for her heart condition. She said, “I’m done. I want to die.”

The doctor accepted her wishes. She had discussed her feelings with her family earlier, and they supported her. She came home under the care of Hospice. Hospice made sure she was comfortable, provided medication to relieve pain and anxiety, and counseled her family. She refused to eat or drink and died peacefully nine days after her heart attack.

Although my sister could speak for herself and did not need her proxy to speak for her, her earlier discussions with her family enabled her to die peacefully, without medical intervention or family conflict. I am motivated to write this letter because of my gratitude to my sister and my wish for peaceful endings for all of us.

Cynthia Aguilar

West Tisbury