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Prepare for End of Life Care and Avoid Grief

By Ira Woods
End-of life care preparation
You see it in the celebrity news all the time. The public sharing of way- too-much personal information, the in-family squabbles, and the dysfunctional dramas played out for the TV cameras. Such was the recent scenario involving the death of Casey Kasem.

Although Mr. Kasem had left advance directives regarding his wishes about end-of-life care, and had assigned his daughter to be his surrogate health care decision maker, or healthcare proxy, his wife didn’t agree with the decisions being made. 

His daughter’s authority, however, was contested by her stepmother, Kasem’s wife. Allegations of kidnapping and starvation played out in courtrooms. Kasem’s wife performed a dramatic interpretation of a Biblical scene for news cameras, throwing raw meat in the street in exchange for her husband “to the wild rabid dogs”- her stepchildren.

Aren’t you glad you and your family are so level headed, and communicate about important issues like end-of-life care? 

The Kasem family example may be extreme, but according to Robert Fleming, lawyer and author, even in the most “functional” of families, similarly emotionally fraught cases come up every year in his practice.

How to Avoid the Conflict around End-of-Life Care

To avoid this kind of drama and ease the unnecessary burden of responsibility put on the family, there are three options for advance directives  available to ensure your wishes regarding end-of-life care are followed.  The first two are legal documents and are upheld by state laws, while the third is a medical directive.

  1. A living will – a declaration or advance directive of instructions regarding your wishes in the event of terminal illness. It outlines the treatments you’re willing to undergo and those you do not want to undergo at a time when you’re unable to make the decision.  It will assist your medical team in determining treatments, even when you’re no longer capable of communicating with them. A living will does not assign a representative for you (see 2 below).
  2. A healthcare proxy –is a document that assigns a representative or agent to ensure that your wishes are adhered to. The representative will make healthcare decisions for you. The proxy would step in when the patient can no longer communicate his or her wishes regarding treatment.
  3. A do-not-resuscitate order – A medical worker will always attempt some type of resuscitation if the heart stops beating or when breathing stops. However, some people choose to bypass any type of resuscitation. In such cases, a Do Not Resuscitate Order (“DNR”) is signed, which is then placed on the individual’s medical chart. If the patient is at home, the DNR is placed in the immediate area of the resting patient.

According to The Hastings Center only 15 – 20% of Americans have written advance directives. Additionally, “studies show that close family members do not always have a good reading of what a patient really wants.” So, don’t leave it to chance.

If you’re looking for a good resource site on this topic, the PBS’s series On Our Own Terms, Moyers on Dying has extensive information about end-of-life care, advanced directives, and healthcare proxies as well as web sites, resources, articles and information. 

The bottom line is, we don’t know when “it” will happen, and our families won’t always know what to do, or what our wishes might be.  And they certainly won’t know what to do if we don’t tell them our wishes in advance.  For instance, the decision to be cremated and to house the ashes in an urn for ashes or to have the cremation ashes scattered, as opposed to a traditional burial, are topics that can often be overlooked and cause the family confusion. The responsibility for your end-of-life care is up to you, and the best time to take care of that responsibility is now – while you still can communicate your wishes. 

Ira Woods is the president and founder of OneWorld Memorials. He had become the primary caregiver for his wife who discovered she had cancer in 2009. His experience caregiving and then losing someone he deeply loved caused him to reach out and encourage others to prepare for this eventuality through writing and speaking.