Who would pull the plug on Grandma?
Let’s get to the heart of the matter right away: ***No one*** will pull the plug on Grandma unless she has left explicit instructions to do so under a particular set of circumstances; or unless the person she invested with her **medical power of attorney** and/or family members agree to do so, after medical experts have determined there is no life left in her body, save for the plug.
So why the political clamor, more to the point, why the [success][1] of such political grand-standing about the end-of-life discussions which might/oughta/should (as we say in Texas) take place between a patient and her doctor before such difficult decisions need to be made anyway? *Death Panels?* Really? I don’t think so. And yet, why would President Obama back down in the face of such hysteric hyperbole? And why should anyone but the patient and her doctor decide what they’re going to discuss on any given day?
I see this as another instance of inconsistency -- you might call it hypocrisy -- in the ways and means of the far right. Hands off capital punishment. *(Some people deserve to die.)* Don’t touch my right to bear arms, and in particular arms designed to kill people. *(I have to defend myself, after all, if it’s me or them.) * But Let *me* decide if you can have an abortion. *(Thou shalt not kill.)* And Let *my* God determine when and how you will die. *(Thou shalt not choose, much less be informed about your choices.)*
These are the kinds of discussions that cannot morph from harsh antipathy to “civil discourse” simply because we'd like them to; they are not rational discussions. One side says “A”; the other says “B”. Repeatedly. Ad nauseum. Minds will not be changed, only votes. And with the votes comes the power -- or so they say -- to decide who lives and who dies, and to make the decisions about how scarce medical resources are expended (on conversations about end-of-life and unwanted heroic measures, say, or on health insurance for the poor). And sadly, power is what’s at stake here -- not my life or yours, and not anyone’s grandmother’s.
So, how do we Grandmas protect ourselves from such abuses of power? There’s a full course of study available from the death-with-dignity advocates at [Compassion & Choices][2]. The three steps to take -- according to these folks -- are (1) **Designation of a health care agent** (someone to make medical decisions for you in the event you become unable to make or convey those decisions yourself); (2) Completion of an **Advance Directive** (honored by all 50 states, incidentally), which specifies what treatments you want or do not want undertaken if and when your condition is believed to be terminal (that is, that medical science predicts you have six or fewer months to live, regardless of treatments you receive or choose not to receive); and (3) **Conversations** with your family, your appointed health care agent, and your physician(s) about your personal values and goals with respect to end-of-life decisions.
I remember my mother telling me that she and Dad had updated their wills and completed “living wills,” which she instead called “dying wills.” She didn’t like doing it. Who would? It requires us to confront our mortality -- ahead of time. But she did it -- to spare her husband and children the agony of true life-and-death decisions she did not want them to have to make on her behalf, and to maintain control over that which she could control until the very end. (And, for the record, she exercised that control, refusing in the course of her last hour on earth the lunch Dad had made for her and demanding in its place a glass of Scotch!)
My husband and I also created our Advanced Directives and appointed our medical powers of attorney when we updated our wills a few years ago. I recall feeling absolutely detached throughout the process; I was deep into denial that anything awful would ever happen to either of us. I was feeling grown up enough to act responsibly, but certainly not old enough to be vulnerable. Our grown kids, however, freaked, as if by refusing to deal with the information we were providing, they could make it unnecessary, forever. And unfortunately, that is simply not the case. The subject will have to come up again soon. File under: The discussion will be difficult; but the decisions will otherwise be impossible.
The government was never positioning itself to pull the plug on Grandma. That’s not the threat. But if you want to [keep your voice][3], even at the end of life, it is important to do your health care homework. Now. And if your parents are still living, have some of these difficult discussions with them now, too. There’s far more peace of mind to be found in an Advanced Directive than in any will.
[1]: http://[http://www.nytimes.com/2011/01/18/health/18brody.html?_r=1&ref=eldercare]
[2]: http://www.compassionandchoices.org
[3]: http://www.nytimes.com/2011/01/18/health/18brody.html?_r=1&ref=eldercare
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