Making Our Values Known

One day in my office, an elderly couple said that they had a document they wanted to add to their advance directive. It went as follows:
"I have a firm belief that God created me, that there is a natural cycle of life, that death is inevitable, and that dying should be peaceful, comfortable, at home, if possible, and without tubes, artificial nutrition and ventilator support. If I cannot carry out self care, do not have my usual mental faculties, or have an incurable disease or intractable pain, please treat me with the best care for comfort but not invasive life support care. It is quite acceptable to withhold fluid and nutrition from me and treat me with a morphine drip as part of this care for comfort, letting nature take its course. I have no wish to be a burden to my loved ones, or to spend resources and energy on heroic efforts to prolong my life when life is at end. Only in the acute situation (e.g. trauma) would I want heroic life support to try to get me back to my present state of good health. My worst nightmare is to spend my days in a nursing home with a feeding tube. Quality, not quantity,of earthly life is more important". I was delighted that they had taken the initiative and that we could talk things over.

This type of statement can be added to one's living will and serves as a very important guide to the physician and your loved ones. The conversation is focused on your values, not just on what high tech marginally beneficial treatment could be attempted. Please consider doing this or something similar such as a Five Wishes form or one from Compassion and Choices. Also, general values statements can be of use.

The ultimate document putting values into medical orders is the POLST form, but this form is generally most applicable in the last year of life, for hospice patients, or for the frail elderly who are sure what they would or wouldn't want in a medical crisis. For the rest of us, the addition of a values statement to our living will (plus having the important discussions with our family, friends, physicians, and durable power of attorney for health care) will be our best assurance that indeed our wishes will be respected.