Death Wishes

September 30, 2005

A trip to a hospital in the 21st century is filled with the wonders of machines and medications, some more familiar than others, all working together for the benefit of patients. There are some that you can put your entire body into and others where they stick you with something and still others where you stand there until they tell you to breathe again. 
Recently a Scout troop was visiting a local hospital and one Scout asked the volunteer who was giving the tour, "What do they do here?" The docent responded, "We make 
people well here so that they can live a very long time." The child looked at the floor and then said, "They must not have brought my grandma to this one."
The Scout had her hand on the very real paradox of the current millennium. The health care system rightly is developed to heal and save lives. But people still die. In our finite human nature, it is clear that at one magic moment we will be born and at another we will die. Everyone likes to talk about birth. Few occasions reduce a group of adults to strange linguistic utterances like someone showing a baby's picture. But when was the last time you were in a group of people showing pictures of someone who has died? Death is just as natural as birth; I just don't want it to happen to me anytime soon!
It is not without good reason that death is a hard topic for dinner conversation. It remains one of the great unspoken realities of our human existence. Last spring, however, it entered our homes and filled the news media. Much can be said of the death of Terri Schiavo, but we need to remember in the same context that there were two deaths that caught the attention of the world. The other was Pope John Paul II. 
No matter how you feel about it, Schiavo's death was a sad affair. But in many ways, Pope John Paul II offered us an alternative. Clearly the physical situations were different. The pope, however, had made a decision to allow himself to return home to God and did so with great courage and dignity. He showed the living an invaluable approach to dying.
If nothing else, the controversy surrounding Schiavo's death prompted dialogues about the subject in our daily lives. With the same passion as the debate on abortion, the end of life became a conscious subject. This case prompted people to think more about advanced directives and end-of-life care. Advanced directives, whether we are discussing living wills or power of attorney for health care, are documents that need to be discussed. Make clear to your family what your wishes are if and when such measures are needed.
The first step is to obtain the forms and fill them out. If you are supporting a relative who lives out of state, please note that directives change by state. Please also note that you are never too young to have advanced directives. As Schiavo's death illustrates, people die at all ages. Before you fill out these documents, you will need to engage in some self talk, or personal reflection. How do you feel about life? If you were in Schiavo's situation, what would you have preferred? Most of us like to think about our death as an event -- death as a Hollywood production, where the cowboy grabs his chest, kisses his horse goodbye and flops to the ground. In the 21st century, death more often is a process, generally not an event. As such, it can be quick or quite lengthy. What advice would you give to your family? One of the hardest things to do is to make these decisions without the input of the person most involved.
The second step, which may be harder than the first and is, in many ways, more important, is to talk with your family. Even if the paperwork cannot be found in a timely manner, if your family has heard you and is in tune with your wishes, it will ease the process. Talk with them. Even adolescents need to think about what they would want done should they die unexpectedly. There is too much pain and grief at the time of a death, and you do not want the ones you love also wrestling with these difficult decisions. This does not need to be an ongoing conversation, but it should be held. It may be one of the most important discussions a family ever has.
Death is the end of life that most of us would rather put off. Even in the age of modern technology and wonder drugs, death happens. Share your thoughts and feelings with your family. Share them in the context of your faith so that the ones you love most and who know you best might bear witness at your death as you did throughout your life.

Ellor, PhD, DMin, LCSW, DCSW, BCD, CGP, is director of the Institute for Gerontological Studies in the Baylor School of Social Work. 

Forms for Advanced Directives and Medical Power of Attorney by state can be found at: or by calling 800-658-8898, sponsored by the National Hospice and Palliative Care Organization.