I recently gave a talk on advance medical care planning at a public forum. During the question and answer period, an older gentleman stood up and announced, “I don’t need all of this. I am going to live to 110 in perfect health!” I admired his optimism. There is scientific evidence that having a positive attitude towards aging certainly increases the quality and quantity of your remaining life! And I don’t want to destroy what hope or optimism he or others have towards the future.  However, I do think it best to be

 

grounded in reality and prepare for the ‘worst case’ scenario. Very few people, less than 5%, of older people die suddenly in their sleep with no active disease or reduction in their quality of life. Many people suffer a decline in their health and become progressively debilitated as they age all the way until their death. The truth is that the longer you life, the more likely you are to suffer a reduction in your quality of life or functional capacity (See Figure). This is an important construct to understand and has implications for your advance medical care planning. As it relates to your future medical treatments for serious illness, doctors will want to know whether they should focus on prolonging your life or focus on preserving the quality of your life. You can’t have them both- they compete or conflict with each other. If the doctors know that you want to focus on prolonging your life, they will use machines and other forms of artificial life supports to keep you alive if necessary, understanding that the consequence will be that they suffer a further reduction in their function or quality of life. If doctors know that you want to focus on quality of your remaining days (and not prolonging life), they would not use such machines and  the implications are that when you are seriously ill, they will let nature take its course and you will experience a natural, dignity-preserving death. There is no right or wrong answer. Understanding what’s important to you is a critical part of advance care planning. 

At a different public forum a few months ago, a woman confessed publicly, “I tried to get my husband here but he doesn’t like talking about this stuff (referring to thinking ahead and planning for illness and death).“ I wish to dispel the myth to that by ‘thinking about this stuff’, it doesn’t jinx you or mean, bad things will happen to you. Quite the contrary, I wish I could have explained to him that his failing to lean into topic will just make it worse for him and his loved ones as he nears the finish line. I respect that some people are private people and don’t want to talk openly about these personal matters. But I wish to say to them that nothing could be more ‘public’ than when you become critically ill and you go to a publicly funded hospital to receive care from strangers like me. So there is nothing private about these matters and your values (what’s important to you) needs to be a matter of public record. Plan Well Guide helps you clarify your values in a way that will be helpful to the doctors in making sure that you get the medical care that is right for you. Do your plan today!

 

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