“And how we deal with death is at least as important as how we deal with life, wouldn’t you say?” – James T. Kirk, Star Trek II: The Wrath of Khan
The Knight discusses his future with Death
Like Captain Kirk, many Americans think they can cheat death and avoid dealing with it – though most are happy to deal with life and many seek to live it as long as possible. And I daresay that most are hoping to live life to its fullest with passion and good health (just check out last week’s blog by Tony DiNuzzo – http://wp.me/pH3Dx-fl). Unfortunately, that is not the case for everyone and even if life is lived well – there is always an end. How do you want your life to end? Are you as passionate about how you want to die as you are about how you want to live?
Americans have the opportunity to declare how they would like to be cared for when they are dying or have a catastrophic illness that renders them incapable of making decisions. However, research studies have found the use of advance directives ranged from less than 50 percent of severely ill patients (AHRQ, 2003) to 67% in those over age 60 (NEJM, 2010). Studies do show that when an advance directive is available, patients generally receive the care they requested (NEJM, 2010). Advance directives come in a variety of formats – living wills, durable powers of attorney for health care, and ordinary written instructions.
I know I would rather make it clear to my spouse, my children, and my primary care provider what is important to me to continue life , what kind of life sustaining measures are acceptable, and when it’s OK to say “good-bye”. But this is frequently a difficult discussion – nobody wants to talk about dying. One method I found that gets the discussion started is an online resource called “The Conversation Project” (http://theconversationproject.org/ ). It contains “starter kits” that help people identify their values and their wishes for the end of life and helps start the conversation with family and health care providers.
So, deal with death in a way that is at least as important as how you deal with life and help yourself, your family, or your patients make their wishes clear.
References
- AHRQ. (2003). Advance care planning, preferences for care at the end of life. http://www.ahrq.gov/research/findings/factsheets/aging/endliferia/#Structure
- Silveira, M. Kim, S. & Langa, K. (2010). Advance directives and outcomes of surrogate decision making before death. NEJM, 362 (1211-1218).
- Star Trek II: The Wrath of Khan. Harve Bennett, (Producer), Paramount Pictures, 1982. (http://www.imdb.com/title/tt0084726)
And… thanks to my doctoral student, Carrie Simmons, for her research on advance directives.
Our Guest Blogger this week is Linda R. Rounds, PhD, RN, FNP, Professor, UTMB School of Nursing.
Join us for a real-time discussion about questions raised by this essay on Tuesday at from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.
Image source: The Seventh Seal. Allan Ekelund (Producer), Svensk Filmindustri, 1957 (http://www.imdb.com/title/tt0050976)
Rodger Marion 
January 20, 2014 at 3:20 pm
I didn’t know that James T. Kirk was so wise!
January 21, 2014 at 1:04 pm
Transcript – Discussion in Second Life – January 21, 2014
[10:22] Rodger Markova: This week’s blog is about advanced directives and such things but I have always been fascinated by the situation shown in the film The Seventh Seal. Do we negotiate with death?
[10:22] Rodger Markova: I’m also interested in how we approach the end of life and to what extent we consider planning for that transition, not in a physical sense but in a philosophical.
[10:23] Tim (tskillian Resident): I think — for me — I approach it in a way leaving a legacy — I think Erikson referred to it as generativity.
[10:23] Mega (Megadeus Resident): so setting the mind up before death?
[10:24] Rodger Markova: Yes. Have you ever considered that
[10:24] Mega (Megadeus Resident): Know untold number died before. allow me to be ok with it
[10:26] Rodger Markova: I’ve wondered if I would have anything so important that I’d argue with death to get some more time, or to get time for someone else.
[10:26] Tim (tskillian Resident): I think that — for me — death is not scary if I have reason to believe my kids will carry on and be happy without me.
[10:28] Mega (Megadeus Resident): I feel I so Ok with it, I may be rude on my view of it…
[10:28] Rodger Markova: No, not rude at all
[10:28] Tim (tskillian Resident): I don’t think it rude Mega
[10:29] Tim (tskillian Resident): I think I feel the same way as you with the caveat of leaving my loved ones to fend for themselves or leaving them in a bad position.
[10:29] Mega (Megadeus Resident): hmm.. unsure I can explain why I ok.
[10:30] Mega (Megadeus Resident): it like moving to higher level, but you no longer yourself, but it need the mind
[10:30] Mega (Megadeus Resident): Dreams have changed my view of it too
[10:31] Tim (tskillian Resident): how so?
[10:32] Mega (Megadeus Resident): seeing the universe speed up you’ll notice it more alive than is looks. on earth seeeing a river slowed down same effect on large scale.
[10:32] Mega (Megadeus Resident): it like we a part of something but not direct.
[10:33] Mega (Megadeus Resident): are souls go in an ocean and become spread out becoming the ocean.
[10:33] Rodger Markova: Interesting. I like to think there are levels of existence. It would be nice to move on to another one after my time here
[10:34] Mega (Megadeus Resident): I see yes there a higher level, but you aren’t yourself. so right now this is as “you” are going to get
[10:34] Tim (tskillian Resident): I hope that is true also — and I like to think so — but I have difficulty believing in continuing to exist after death.
[10:34] Rodger Markova: Yes, but I’d hate to lose me
[10:35] Mega (Megadeus Resident): I question it, as I have seen real ghost. nothing like kinda on TV
[10:35] Mega (Megadeus Resident): unless my brain messing with me
[10:36] Rodger Markova: The notion of a next existence as some integrated part of a larger whole seems as aimless as simply ceasing to exist after death
[10:37] Mega (Megadeus Resident): all a mystery
[10:37] Rodger Markova: There is some sort of magic in being sentient that must transcend time and space
[10:38] Tim (tskillian Resident): do you think that belief in an afterlife is necessary for meaning in this life?
[10:38] Mega (Megadeus Resident): or scary to think none of this is really real
[10:38] Mega (Megadeus Resident): so many views can be confusing indeed
[10:38] Rodger Markova: yes
[10:39] Rodger Markova: I’m not too concerned if this is real however. It simply is
[10:39] Tim (tskillian Resident): I hope there is a magic that transcends time and space
[10:40] Tim (tskillian Resident): and sentience that transcends time and space
[10:40] Rodger Markova: I’m sure there is magic in the world
[10:40] Rodger Markova: Not too sure about reality however.
[10:41] Tim (tskillian Resident): Perhaps, but my life still has great meaning and I feel highly motivated to spend time wisely while here
[10:41] Rodger Markova: Yes, very well said
[10:42] Rodger Markova: My son has recommended the artist, Gregory Crewdson, to me and I’ve been looking at his work. He gives an interesting viewpoint to reality.
[10:42] Tim (tskillian Resident): Mostly, I derive meaning from making the world a better place — first for my kids — then for everyone else.
[10:44] Rodger Markova: Here is a link: http://www.youtube.com/watch?v=S7CvoTtus34
[10:44] Mega (Megadeus Resident): this got me think of the question to meaning of life now… that bugs me
[10:44] Tim (tskillian Resident): I am perusing some of the images now, but need more time to absorb them.
[10:44] Rodger Markova: How so, mega?
[10:45] Mega (Megadeus Resident): just an uneasy feeling
[10:46] Rodger Markova: As I recall in the Hitchhikers Guide the meaning of life is 42?
[10:46] Mega (Megadeus Resident) smiles
[10:47] Mega (Megadeus Resident): watching the movie, had interesting view point on our world
[10:47] Tim (tskillian Resident): I was watching it too. 🙂
[10:47] Tim (tskillian Resident): look forward to finishing it.
[10:48] Mega (Megadeus Resident): I linked that youtube vid, I plan to watch it. look interesting to watch
[10:49] Rodger Markova: We are out of time for today. Thank you for attending. I think we had a good discussion and remember to go check your living wills.
[10:49] Tim (tskillian Resident): This has been a good discussion Rodger and Mega — I am sorry, but need to. Back the world of grant writing. I appreciate the few minutes taken to reflect, however.
[10:49] Rodger Markova: See you again
[10:49] Tim (tskillian Resident): yes. bye for now everyone.
[10:49] Mega (Megadeus Resident): bye