December 05, 2011

I’m not currently close to death (so far as I know), but I nonetheless logged on this week to the Aging With Dignity Web site, and thought through my Five Wishes for when my time approaches. Envisioning my family reading what I had written made me, quite honestly, melancholy.

The overall experience was profound in a richly positive sense, however. It was not unlike the feeling of connection one senses on those rare and beautiful occasions when the world slows down and the bond frays between the mundane and the mystical: looking into your newborn’s eyes; feeling small on a deep, starlit night; realizing love; sitting with a person we love as they transition beyond this life.

How often do we humbly take stock of the meaning of our lives, and the lives that will go on when we are gone? It can be solemn and powerful to do so, even in the context of a crisp autumn day when one is in the best of health.

With its straightforward choices, Five Wishes guided my journey.

At its roots, Five Wishes is a legal document, recognized in 42 states and the District of Columbia as a legitimate form of a living will or durable power of attorney for health care. The new online version costs $5 and gives people 30 days to ponder their choice of a health care agent and specific medical treatments they wish to have or forgo at the end of life.

It’s extremely useful because it presents in simple and specific language life-support options ("medical devices put in me to help me breathe," food and water supplied by a medical device, CPR, major surgery, blood transfusions, dialysis, antibiotics) in different contexts (coma, permanent and severe brain damage, approaching death), allowing people to specifically detail their advance directives.

But there’s a difference between Five Wishes and standard advance directives forms familiar to all of us.

Many of the Five Wishes reflect life, not just the end of life.

And that is why I feel it is a noteworthy document for all of us to fill out personally, and, as medical and mental health professionals, to share with individuals or families in our practices. Wish Number Five, for example, offers the chance to check off boxes concerning "What I want my loved ones to know" -- the first choice being, "I wish to have my family and friends know that I love them."

Other choices within the Wish include, "I wish for all of my family members to make peace with each other before my death, if they can," and "I wish for my family and friends to think about what I was like before I became seriously ill. I want them to remember me in this way after my death."

Wish Number Five also provides a space for thoughts about how one wants to be remembered, and what music, songs, or readings they might wish to be included in their memorial service.

Wish Number Four is no less individualized, and warmly embracing of the individual’s mental, emotional, and spiritual being as well as his or her physical body.

"I wish to be cared for with kindness and cheerfulness, and not sadness," reads one possible wish.

That was easy for me, as well as most people, I would think, and I checked it off.

But others were less straightforward. Do I want to have my favorite music played when possible until the time of my death? Honestly, not every minute. Sometimes when I’m sick I would prefer the quiet presence of a loved one, or silence.

I am a spiritual but not a religious person and checked off boxes to reflect my personal preference to not have prayers read by my bedside, while others might choose the opposite.

I’ve been personally and professionally involved in cases where religious preferences of relatives came into conflict at the end of life. Explicitly stated wishes could certainly have prevented many of the painful misunderstandings and power struggles over this.

On through the wishes I meandered, selecting some for myself, rejecting others, while considering how my decisions might be seen by my family. We plan holiday get-togethers this month, and I’ll be broaching the subject with them in a spirit of openness, respect, and warm concern for them now and in less bright days that the future may hold.

My hope is that they will also fill out their Five Wishes, and we can talk, just as I have guided families to talk, but with less pressure and more wisdom all around.

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