A recent article in the N.Y. Times set out some new boundaries on the discussion regarding end of life care and the role of the family and the physician concerning who makes decisions. The piece, in Friday August 1, page A-11, is entitled “French Families Challenge Doctors on Wrenching End-Of-Life Decisions”. It seems that in France doctors have a much greater ability to decide when a person;s life may end. It seems that recently there has been a rising tide of concern about this issue and the role of the doctor. A doctor was acquitted of “poisoning deaths of seven people”. As the article states: “Demographic pressures are making end-of-life care a contentious moral, legal and economic issue in many countries. Aging populations and the growing cost of caring for them have left governments confronting trade-offs in policies affecting the closing weeks and months of life”.

I mention this article because it is an example, I feel, of a growing trend, sparked in large part by Boomers. We want “in” on decision-making, we want a say in how we may choose to live out our final days. The system in the USA is also changing. There are now five states that have passed a “right to die” bill. My own state of New Jersey has such a bill in the legislature and it should emerge again in the next session. This all points again to the need for families to have “the conversation” about one’s wishes. It just makes a lot of sense on several levels.  There are a wide variety of tools that have been created to help facilitate these discussions. Organizations from “The Conversation Project” in Massachusetts to the creation of a national day devoted to health care decision-making (mid April) are all over the net. Increasingly religious organizations will hold forums and seminars that teach this issue from their own theological slant. All of this is needed. Medical technology continues to push that boundary of sustaining life. As some have noted, however, just because medicine can do something does not mean that we must or should.

This issue is heart of our social fabric. The more knowledge and discussion around it, the better we all will be.

Rabbi Richard F Address, D.Min


1 Comment

  1. Editor’s Note: This comment comes from Jewish Sacred Aging contributor Ag Herman:

    In the excellent “Glowing Global Conversation” Rabbi Richard Address confronts a subject that is current, not only for “boomers” but for all of us. Death is, as we understand or should understand, part of life. The end of life is as important as the beginning for those who bear witness. As my friend the rabbi points out, families must have The Conversation to be part of the decision-making process regarding end of life decisions. If Boomers want “in” and want to express their wishes, they cannot wait to discuss this subject upon entering the hospital or at bedside.
    My cousin at age 83 was taken to emergency with kidney failure. She said to the nurse and to her companion, “Please, no dialysis, just leave me be!” She was exhausted, childhood polio had returned and put her back in a wheel chair. She had enough, but the doctor had nothing in writing. He felt obligated to move ahead with dialysis. We needed a court order to stop the doctor and fulfill my cousin’s wishes to be left alone to die peacefully.
    An Advance Directive spells out one’s end of life wishes in detail; it is signed and witnessed, it guarantees the fulfillment of personal wishes. The directive should include the designation of a decision maker, a health care agent; a chosen family member or friend who makes sure your treatment follows your wishes and makes medical/comfort choices should you be unable to do so.
    Call it an Advance Health Directive, a Living Will, Five Wishes, or let it be a simple signed and witnessed statement that you have created. The Conversation should take place first in the comfort of the living room or the intimacy of the kitchen table. Whichever provides a comfort zone of privacy? The discussion between my husband and I began as we sat together in our love seat.
    I simply asked: “How will you get along if something happens to me?” His answer led to more questions a widening circle of personal wishes concerning medical decisions, funeral arrangements and clergy people. Like a rolling snowball picking up snow, the subject picked up a variety of related subjects and finally arrived at choices, hopes and significant wishes.
    Guidelines for end-of-life wishes are fundamental, clear and a difficult subject to look at. Many of us at sixty feel healthy and omnipotent, why talk of death? A document called Five Wishes is acceptable in most states, including California, as an advance health directive. Five requisite wishes to discuss and record are:
    • • Which person you want to make health care decisions for you when you cannot make them yourself?
    • • The kind of medical treatment you want or do not want.
    • • How comfortable you want to be.
    • • How you want people to treat you.
    • • What you want your loved ones to know.

    Wishes concerning organ donation, autopsy, the relationship between your primary care physician and your health care agent can be included. Forms are available from your doctor, hospital, hospice, a stationery store or the Internet. As the rabbi said, “The more knowledge and discussion around it (end-of-life wishes) the better we all will be.”

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