You probably know that April is National Healthcare Decisions Month. There was a great article last week (in The Gainesville Sun) written by the collective hospital teams from UF Health and the VA asking our community to “consider the importance of advance care planning.”  Perhaps you added your thoughts to the “Before I Die” walls around Alachua County that are part of this community initiative called “My Voice, My Choice,” and pondered what you would like to accomplish in your life before you die.

The entire point of these walls is to generate conversations around death and mortality. Please allow me to add this thought as well to your “ponder list.”  What do you think about when you hear the phrase “a good death?”  You may laugh at placing “good” and “death” together, but anyone who works in a medical setting will tell you that a good death is possible. With Covid, our medical front line workers witnessed first-hand far too many bad deaths. A good death is one that happens the way you hope and plan for, to the degree that this is possible.  A good death means careful consideration, thoughtfulness, and the willingness to communicate with your loved ones; family and friends, and your doctors about your end of life wishes before a crisis.

When anyone tells me they don’t want to burden their families with making these types of decision, I tell them what the standard protocol is when they arrive at a hospital without any advance directives. All hospitals have dealt with this exact scenario, so they have a written ethics procedure that requires them to follow a specific order of who to contact first to make a life-or-death decision:

• Spouse or Legal Partner
• Adult Children
• Siblings
• Friends
• Neighbors

You can see that no matter what, your family will be contacted.  They will be guessing about what treatments you do or do not want to receive if you have not told them. There is nothing worse than watching a traumatized family member admit they have no idea what a beloved parent wants when their parent can’t speak for themselves.  The family member can refuse, and the hospital will continue down this list. If there is literally no one, then they contact a social worker or chaplain at a different hospital and this person, a perfect stranger, will make the call. Nobody wants this to happen. Completing a living will and appointing someone as your health care proxy is a gift to your loved ones.  But the time to ponder how you want to die should start long before any kind of terminal diagnosis, or trip to the ER.   So how does one plan for a good death?

Dr. Samuel Harrington (honors graduate from Harvard and the University of Wisconsin medical school) talks about this in his thoughtful book, “At Peace: Choosing a Good Death After a Long Life.” Most people say they would like to die quietly in their home, but often this is not the case.  More than twenty five percent of older people die in the ICU without a living will, and far more die after prolonged possibly unnecessary treatment. His book looks at why this happens and makes clear and knowledgeable suggestions. He states that “overly aggressive medical advice, coupled with an unrealistic sense of invincibility or overconfidence in our health-care system, results in the majority of elderly patients misguidedly dying in institutions. Many undergo painful procedures instead of having the better and more peaceful death they deserve.” His book is the best practical and informative guide I have read on educating the reader about making intelligent choices on medical treatments as they relate to specific diagnoses.

It was somewhat confronting to read Dr. Harrington’s opinion based on thirty years of clinical experience: that the American health care system was not designed to treat the aging population with care and compassion! While not always true, what can be done to improve your outcome?   The key again is communication. Be willing to think deeply on this topic. Make decisions based on your values and wishes and ask your doctors to be realistic about your options and chances for recovery before saying yes to all treatments.  And for the sake of your loved ones, don’t ask them to guess. Complete your advance directives now, and let your wishes be known.