Hello everyone! I'm Traci Arieli, an end-of-life doula and founder of Comforting Closure. Today, I want to talk to you about something that might be difficult to discuss but is incredibly important: end-of-life planning, specifically advanced directives. Many people avoid this conversation altogether because it can feel overwhelming.
When we think about end-of-life planning, it's not just about financial matters. It's about envisioning the quality of life we want during our final moments. Personally, I’m lucky in that my parents have prepared their financial plans – and they have reviewed those with my siblings and me. But they did not come to the conversation ready to talk about what they want their end-of-life care to look like. And when my siblings and I brought it up, it was very evident that my parents, like most people, did not have enough information to make decisions about their end-of-life care, and that my brothers and I had very different views on what quality-of-life meant.
Understanding what you want your quality of life to be during your final days can make decisions about your care much easier. Do you want to remain at home? If community service been an important part of your life and you’d like to donate your organs, you need to plan for that especially if you choose to die at home. Have you always been active and love being outdoors – what does that mean for end-of-life measures like being on a feeding/breathing tube? How do you want to include those things that are important to you into your environment? There's a lot to think about, so take the time to envision your ideal end-of-life circumstance.
It's also essential to communicate your desires to your loved ones. This way, they will have a better understanding of your wishes when you're unable to express them. Engage in discussions not only about the what but also the why behind your choices. The legally binding aspect of an advance directive is appointing a healthcare agent and stating your healthcare instructions. Your appointed healthcare agent will make medical decisions on your behalf when you can't. Since many situations cannot be accounted for in the advanced care document, it's crucial for your healthcare agent to understand your beliefs and values.
To prepare for this conversation, educate yourself about the components of end-of-life planning. Familiarize yourself with an advance directive and consider how you would fill it out based on your preferences.
It's also important to educate yourself about the realities of life-sustaining measures. It is not like what’s on tv. When I was studying about life-sustaining measures for myself, I was surprised to learn that the CPR survival rate from cardiac arrest that occurs outside of the hospital is around 8-12%. CPR survival rates for in-hospital cardiac arrest is about 17-26% (depending on the study). As age increases (or your health decreases), those percentages go down. If you do survive, the physical complications of CPR more than likely will include broken ribs, it might include a punctured lung, pain, and brain injury. Understanding the potential outcomes can help you make more informed decisions. Dr. Zubin Damania made a great video on the subject. I’ll be sure to post a link to it in the description section of this video.
Be prepared to guide others in the conversation as well. The Conversation Project is a valuable resource that provides information to help you navigate these discussions.
When you're ready to have the conversation, choose the right time and setting. Approach it with empathy and respect, as this is a sensitive topic. Be a good listener and allow the other person to share their thoughts and concerns.
After these conversations are complete, be sure to document your wishes in an advanced directive. There are several options out there, like the Five Wishes Organization, and I’ll provide links to some of those options.
If you are older or have a terminal illness, you should also work with your doctor to document your wishes using a POLST document. POLST stands for Physician Orders for Life Sustaining Treatment and is a medical order from the doctor outlining your wishes.
Without your end-of-life wishes documented, if you have a serious event and you end up in the hospital without family members there, doctors will default to taking all necessary interventions to keep you alive. And once measures like breathing tubes are in place, depending on the hospital, it might be very difficult to remove those measures.
Having end-of-life planning conversations may not be easy, but they are essential. By discussing your wishes and preferences with your loved ones, you can ensure that your end-of-life care aligns with your values and desires. Remember, this conversation is an act of love, allowing you and your family to face the future with peace and understanding.
Thank you for taking the time to watch this video. If you have questions, please comment below or reach out to me directly.
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