Why end-of-life documents should be fluid

“Code Blue!” A voice cries out in the Emergency Department. “Is there a doctor who can ‘tube’ a patient in Cardiac Cath Lab?”

These beginning lines of “Wishes To Die For: Expanding Upon Doing Less in Advanced Care Directives,” by Dr. Kevin J. Haselhorst, prepare the reader for an adventure in self-examination.

The first chapter, titled “Self Determination,” describes the author’s own internal battle to balance his training as a doctor who cures at all costs with the wishes of his patients. Through his book, Haselhorst gently encourages us, the potential patients, to examine our right to decide how and under what circumstances we will be allowed a natural death.

With short but thought-provoking chapters, the author makes the case that a document expressing our end-of-life wishes should be fluid, changing with our age, our health and our own fluctuating point of view. The treatment that we would choose when we are 40 may be drastically different from that which we’d choose at age 80.

In “Wish 10: Pre-Stamp Three Coins in the Fountain,” Haselhorst writes, “I cannot remember the last time that I wished for a feeding tube, dialysis or ventilator.” The author is not negating the importance of these treatments, but he is stressing that we must keep a record of our wishes up to date. He challenges us to examine what we really want at each stage of life. Any of the above efforts to increase our chances for survival may be a correct choice under some circumstances, but there often comes a time in our lives where less treatment is in our best interest. Unless our current wishes are made known, we may not be able to choose the manner in which our life comes to a close.

While reading the book I highlighted, underlined, and clipped colored markers on pages, thinking to myself that I must include this quote or that paragraph as I wrote. Before long, I realized that scores of quotes would be needed to do this work justice. The complete book with everything in context is needed before the reader can grasp the manner in which Haselhorst guides readers through their own journeys of self-examination.

That being said, what Haselhorst writes toward the closing of his book comes close to summing it up. He says that, “Death with dignity is only realized through the empowerment attained from engagement (of the patient).”

To address this belief, Haselhorst has designed a wristband similar to the well-known Livestrong Foundation wristband. The difference is that this band is bright yellow on one side and embossed with the words “Alpha care,” meaning that the patient wishes doctors to keep trying all routes to keep him or her alive. The reverse side is a subdued blue and embossed with the words “Omega care” indicating the patient’s wish to be allowed a natural death. With a twist of the wrist band, a patient can communicate his or her current thoughts.

“Wishes To Die For” is an intellectual book, best absorbed chapter by chapter. In my opinion, it’s well worth taking this journey with the author to help us clarify our own beliefs. For more about Haselhorst and his work, visit www.wishestodiefor.com. The book “Wishes To Die For” is available at Amazon.com.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carolbursack@msn.com.

~ Minding our Elders: Why end-of-life documents should be fluid by Carol Bradley Bursack