The Life-or-Death Answers We Owe Our Loved Ones

His name was Bob. He was 82. The way he decided to die should speak volumes about the way the rest of us can choose to live.

For many years, Bob had suffered from a serious chronic heart condition. With Bob’s health woes mounting — and his quality of life suffering — a team of surgeons and nurses prepared in a hospital to do exactly what our medical system is programmed to view as the next step: open-heart surgery.

There was a chance he wouldn’t survive being on the operating table. There was a chance he wouldn’t survive the long and grueling aftermath of recovery and rehabilitation.

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So Bob decided to take the biggest chance of all. He said, Stop. Let’s pause for a moment. Let’s talk about what we’re about to do here and, especially, about who wants to do it and why.

He met with his daughter and son, and together the family decided that a major operation on an 82-year-old man with a chronic cardiac problem just didn’t make sense for his own values or life. He didn’t want his last breath to be in a hospital surrounded by strangers. He canceled the surgery, returned home, received palliative and hospice care and died in peace in his own bed surrounded by loved ones.

Engaging empathy and humanity

Our health care system is set up to engineer medical miracles. We have the doctors with the skills, the hospitals with the equipment and the biomedical engineers with the technology. Too often, what we lack, though, is the crucial pause to engage our empathy and humanity.

As a critical care nurse and CEO of a complete senior health company, I have seen too many seniors traumatize themselves — and their loved ones — by delaying any talk about death. That’s why I found inspiration in Bob, his family and their difficult personal choice.

How do we want our life to end? It’s not always up to us, but too often that question must be answered with a hunch or a guess by our loved ones and our health care workers.

Fewer than half of all Americans over 50 years old have recorded their medical preferences for the end of life, according to a poll by AARP and the University of Michigan. Why? Of the people without any medical directive document, 62% said they had not gotten around to it, 15% did not know how, 13% said they do not like talking about death, 13% did not think it was necessary, 9% said no one asked them to, and 7% were deterred by cost.

The financial consequences of death go unplanned, too. More than half of Americans don’t have a will, Gallup found, and the avoidance even extends to those with the most to lose: One in five Americans with investable assets of $1 million or more have no will, according to the Wall Street Journal, citing a Charles Schwab survey.

Avoiding the gut-wrenching choices

Nobody enjoys talking about death, but ducking the subject just saddles everyone else with gut-wrenching choices. Is it really fair to make your spouse or kids wring their hands over the decision to put you on a feeding tube, or a ventilator, or dialysis? After a certain age, or after certain prior health conditions, should you be resuscitated after a major stroke, heart attack or seizure? What if dementia strips away your ability — or your spouse’s ability — to make key life-or-death decisions?

In a medical emergency, the reality is that health care professionals will begin life support immediately unless there is a clear directive saying you don’t want it.

That will be the preferred decision for many Americans with personal or religious reasons to always extend life. A Kaiser Family Foundation/The Economist poll shows, however, that only 19% of Americans believe the top priority for end-of-life care is preventing death and extending life as long as possible. A far greater majority, or 71%, says it’s more important to help people die without pain, discomfort or stress.

When asked to list the leading preferences for their own deaths, the top priority, listed by 87% of respondents, was to make sure their family was not burdened financially by their care. The least important priority was to live as long as possible.

For people who want a good death more than a prolonged death, the U.S. has excellent palliative care and hospice care. Death can come with more compassion than pain, in your home instead of a hospital, surrounded by loved ones who know your hopes instead of medical professionals who can only guess.

What you can do

Try putting yourself in the shoes of your family, friends and doctors. What should they know about your last wishes if you are too incapacitated to tell them?

The best solution is to write a legally enforceable will that has clear medical directions and responsibilities. Many states allow you to download online advanced care directives. Work with a lawyer and consult your primary care providers for guidance.

You owe the key people around you an indisputable written record or personal video interview spelling out what should and should not be done at the end of your life.

Bob was brave enough to be clear about his final wishes with his family. We should be brave enough to follow his example.

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