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when I’m near death

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Who’ll make medical decisions on my behalf should I be unable to do so on my own? Who’ll say when my quality of life has deteriorated to the point where further treatment should be terminated? Who, in short, will speak for me and ensure that I die a reasonably good death? Nothing morbid about these questions, given that there’s a 100% certainty that I’ll die one day and complicated by the fact my next-of-kin (two brothers) live 8,045 km (4,099 miles) and diverse beliefs, cultures, and languages away.

How about you: who’ll make decisions on your behalf should you be incapacitated after, say, a car accident, brain infection, severe stroke, or similar tragedy? Chances are that none will happen to you — chances are equally strong that something horrible will strike you tomorrow, the day after, or ten years from now. We all know of someone who seemed healthy one day and was told of life-threatening disease the next. Or others who happily departed in their vacation, never to return alive. I know of four people in my immediate circle who’ve been given a terminal diagnosis, who’re undergoing radiation and chemo treatment, as they wage their “courageous battles.”

Over the next few posts I plan to explore such topics — with the intention to lure death (not as abstract concept but as yours and mine) out of the closet. How might we prepare for the inevitable — spiritually, legally, financially, etc.? What arrangements might we put in place to help ourselves and others make important near-death decisions? What conversations might we have with friends about the ways we’d like to die and have our bodies disposed of? What medical-ethical issues deserve our attention. e.g., quality of life, palliative sedation, assisted suicide, heroic measures, do-not-resuscitate orders (DNR), living wills, and representation agreements?

Kindly exhale and stay tuned.

image: “By the deathbed” (1896) by Edvard Munch (1863-1944), Norwegian painter and print maker.

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15 responses »

  1. So what do you make of the two ghostly figures in the background

    Reply
  2. Hello Peter
    a great post I think this topic is often avoided as it seems uncomfortable or unneccesary and I have learned on a personal level even with knowing someone very well having spoken about wishes the decisions are still difficult to make as not everything is completely covered. looking forward to the next few posts so as to make my journey for someone else as simple as possble
    hugs ella

    Reply
    • that’s my intention, ella, to open th topic for individual reflection and open-hearted conversation. it’ll still be difficult when someone (you, eye) dies, but we owe it to those who stay behind to express our wishes.

      Reply
  3. Hello Peter,

    Thank you for engaging this topic. I am a nurse working in a geriatric health care center with end of life and hospice patients. I also lost my nine month old son and father in law in a motor vehicle accident two years ago. These are questions and topics I am faced with everyday. I look forward to what you have to share.

    Reply
    • dear mikael, you dor such important work — thank you. My heart softens at the thought of your loss. may your son and his grandpa’s death be a blessing on you. I’ll keep you in mind as I write future posts. peter

      Reply
  4. Such relevant questions Peter that seem so difficult to get around to answering until… in some cases it is too late. And they need to be reviewed more than once because circumstances can change. When my partner first had his stroke there was a no resuscitate order as he wasn’t expected to live and if he did, he it wasn’t anticipated to be able to talk or walk and would have severe brain damage. However, he did live. He did learn to walk and talk again and the brain impact is limited to word finding and is now almost not noticeable. The order has been removed.

    Each of us is unique and so I look forward to your posts and the comments because I do not have solid answers for some of these questions… there is a fluidity in my thinking as if I don’t need to decide just yet.

    Reply
    • thank you, terril, to write about your experience with david’s stroke. may you both continue to thrive in each other’s love.

      there are no solid answers, as you know so well. but we’ll do our loved-ones a great service by sharing our hopes and wishes re end-of-life care. their burden will be huge at the time of our severe illness and/or death. let’s do this sooner than later :-).

      Reply
  5. Peter:

    As you explore end-of-life issues and how one prepares, I hope you’re able to find some useful information at the Compassion & Choices website. We’ve a whole section devoted just to planning:

    http://www.compassionandchoices.org/care/planning

    Our Good To Go Tool Kit is free, and contains a great many resources as well:

    http://www.compassionandchoices.org/documents/G2GToolkit.pdf

    Please feel free to contact me if I can provide additional information or answer questions.

    Carla Axtman
    Online Community Builder
    Compassion & Choices
    compassionandchoices.org

    Reply
  6. Hi Peter,
    The painting you chose is particularly relevant to the topic. I had a chance to visit the National Museum of Art in Oslo a few years back, and one of the surprising things in the collection of Norwegian folk art was the number of painting dealing with death of a child, spouse, or parent. Probably a quarter to a third of the paintings had this topic. And the people were always at home, in bed, with family around them.

    Reply
    • Dying at home, with family, friends, neighbours,clergy — what happened to that? Too much distancing and leaving it to professionals. when i worked at hospice I noticed all too often that people fled the room the moment death had occured. do you do funeral/memorial services as a Kporea Zen monk? what happens at time of death, before and after? thank you, Chong Go.

      Reply
  7. Big questions indeed.
    My mother with advanced Alzheimer’s was given a pacemaker last year when she developed an arrhythmia that would have led to (a painless and welcome) death. This was in large part because both she and my father were terrified of dying and couldn’t entertain thinking about these questions. As if not thinking about it meant not dying. Someone (I can’t remember who) said that “we in North America treat death as if it were an option.” As my sisters and I now try to have this pacemaker turned off, and as my husband and I struggle with the shock of his recent cancer diagnosis and all that it involves, I realize that these questions are as much about how we want to live and how we honour ourselves and those we love, as how we die.

    Reply
    • yes, karen, living and dying consciously are all one. you’re dealing with difficult situations at two fronts: this is the edge of your practice, where comfort rubs up against the unknown. may you find solace in each breath.

      Reply
  8. very timely reminder

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    • hi nancy: how are your Will (current?) and Representation Agreement? Who is clear on your wishes regarding health care, heroic measures, end-of-life care? et cetera.

      Reply

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