Dr. Mor's Column - December
A Decision that Breaks Your Heart

By Eva Mor, PhD, author of Making the Golden Years Golden

My father suffered from Parkinson’s disease for 14 years, the last six of which he was fully impaired by the illness. As a survivor of the Holocaust, he avoided dealing with issues involving death, so he never wrote out a will or instructed us regarding his last wishes. There would always be time for that later, he thought.

When "later" came, my mother said that my father did not want heroic measures to be implemented to unnecessarily prolong his life. I was never privy to these conversations. None of his wishes regarding the care he may require at the end stages of his life were in writing.

A month before my father died, he came down with a very severe cold. It developed quickly from an upper respiratory infection to pneumonia, and we had no choice but to hospitalize him. His condition became critical and he was transferred to an intensive care unit. My whole family stayed by his side 24/7. After much argument among members of my family, he was put on a respirator; he was still conscious at that time, could communicate in writing, and was included in decision-making regarding the respirator.

My siblings, mother, and I put everything on hold to stay near my father. It was clear that my father drew a great deal of support from his children and his wife being by his side. Two weeks into his stay in the ICU, my father suffered a massive heart attack. He lost consciousness and never regained it. The doctors kept performing all kinds of neurological tests, as per our demands. But more grim news kept coming back: no brain activities could be detected, and their recommendation was to remove my father from life support equipment.

His organs were failing one by one, and though we knew that the only thing keeping him alive were the machines, I could not give my consent to pull the plug. My father never specifically told me what he wanted me to do for him if such a situation presented itself. We all agonized, debating among ourselves and struggling with the decision, with the doctors pressing us to commit to a course of action. To our eventual relief, the decision-making process was taken out of our hands three days later, when God mercifully took him.

Helping and Guiding Your Loved Ones in Making Health Decisions for You

If there is a lesson in my personal story, it is this: Do not procrastinate. Write down your wishes. Designate a person or persons whom you want to make those decisions when you are unable to do so yourself. It makes it easier for your own peace of mind as well as for the people who love you, allowing them to follow your requests, rather than stumble through their own guesswork.
The following are two legal instruments that you can put into place that can reflect your wishes as to the care you should or should not receive at the time that you are unable to express it.

Health Care Proxy or Durable Power of Attorney for Health Care:

In either document, you can name someone to make medical decisions for you, should you be unable to make those decisions yourself. The person you appoint may be referred to as “health care agent,” “medical power of attorney,” “surrogate,” or “attorney-in-fact.” The designated person must understand that she or he will need to avail themselves to the medical care providers when any medical decisions are to be made. You do not want to choose a representative that lives in another state from you, or one that is physically unable to be available to your medical team in a time of need.

You can be the final judge as to what should or shouldn’t be done to you. These important documents can include mechanical intervention in cases of respiratory failure, or dialysis due to kidney failure, and if hydration and gastric feeding tubes should be inserted. You can decide how much or how little medical intervention you want at the last stages of your life. With the Health Proxy or Durable Power of Attorney for Health Care, you empower a person you trust to carry out your wishes. These documents are much like a will but they deal with medical issues rather than with financial ones.

Leaving your health care decisions to others without any guidance from you places a great burden on your loved ones during a very traumatic time. If there is more than one opinion regarding your care from several loved ones, there is an unnecessary strain among them that is preventable. Worse yet, if there is no health proxy and no next of kin, a judge may appoint someone who you are not familiar with to make medical decisions for you. That person may not know what your values, beliefs, or preferences are.

There are standard forms, at no cost to you, that are available at any hospital, nursing home, and the offices of any state agency that deals with health issues. You need two witnesses to attest to your signing. Some doctors as well as hospitals will refuse to follow verbal instructions unless a written Durable Power of Attorney for Health Care or a Health Proxy is in place.