Have You Had “The Talk” with Your Children?

No, not THAT talk! Most of us are well past that time in our lives. The talk that I am referring to is the talk about your wishes for the end of your life. We all will reach that day someday – and it is important to prepare yourself and your family for the decisions that will need to be made. I have included below, a very thoughtful letter that a client of ours prepared stating his wishes for the end of his life. Obviously, I have taken out the names, but I thought this was such a sincere and well thought out philosophy statement that I want to share it with you. Hopefully this will inspire some of you to talk to your family and/or friends about these topics. You may feel as this client does that no measures should be taken if faced with a meaningless existence and perhaps even euthanasia may be warranted – or your thoughts may be different. This might feel like an uncomfortable topic, but our experience is that getting these things out in the open takes away one more thing that might keep you up at night – and we all need our sleep!

Here is the letter

_________________, 2023

To: My family, friends, my primary care physician, and all those others concerned with my care.

I, ________________________, being of sound mind, make this statement as a directive to be followed if for any reason I become unable to participate in decisions regarding my medical care.

This letter is not intended to impair or bind the absolute discretionary authority given to the agents named in my Massachusetts health care proxy, nor is it intended to override or revoke any provisions of my health care proxy. Rather, this letter is intended to guide my agents as they exercise the discretionary authority vested in them by that document.

At my last birthday, ___________________, I was ____ years old. I have been fortunate to live a life of great joy, in part, because of your wonderful love and/or care for me. That has been a sustaining blessing in my life. I consider the opportunity to love and care for you to be a blessing as well. I will be forever grateful to have shared life with ______________ and each of you.

What matters most to me as I approach the end of life is that I don’t linger when I am no longer able to take care of myself and/or I am no longer mentally competent. I want to live only so long as my quality of life is good, I can make meaningful contributions to the people around me, and I am able to live independently.

I do not wish to become a resident of a nursing or other such facility where, in order to stay alive, someone else would need to take care of my personal needs for a period of more than three consecutive months. I would not wish to be a financial burden on anyone.

I direct that life-sustaining procedures should be withheld or withdrawn if I have an illness, disease, injury, or experience extreme mental deterioration such that there is a less than 75% chance that I will recover within 3 months to live a meaningful quality of life that I have defined above as the ability to make meaningful contributions to life and to live independently. Life sustaining procedures that may be withheld or withdrawn include, but are not limited to: surgery, antibiotics, cardiopulmonary resuscitation, respiratory support, and artificially administered feeding and fluids.

I further direct that treatment be limited to comfort measures only. I wish medication for pain and other distress to be used liberally in doses sufficient to relieve the symptoms even if the medication were to shorten my life.

I have experienced friends and relatives who have suffered a severe decline in their cognitive abilities; I have been concerned that one day I would develop some form of dementia or mental incapacity defined by any of the following criteria:

§ An irreversible condition that causes severe decline in cognitive abilities including; o Inability to recognize family and those loved by me. o Inability to perform ordinary functions of self-care and cleanliness. o Inability to feed myself o Repeated violent or disruptive behavior. o Disorientation or wandering off frequently. o Chronic confusion about my situation. o Incoherence and/or inability to communicate intelligibly. o Chronic fearfulness or frustration due to cognitive disorder. o Inability to use my cognitive abilities to make a positive contribution to lives of those around me.

If my behavior meets any of these criteria, it is my strong desire to be allowed to die as quickly as possible including being taken some place where euthanasia is practiced and legal. It is my desire that my caregivers follow directives outlined below relating to treatments and supportive actions:

§ If possible, I want to be taken to a jurisdiction where it is legal to hasten the end of my life.

§ I want no measures taken to prolong my life.

§ I wish to be kept comfortable free of pain and maintained in a dignified manner.

§ I wish any medication that is used to keep me comfortable and free of pain or other distress to be in sufficient dosage that distress, physical or psychological, is relieved, even if such medication hastens my death.

§ If I get an infection do not treat it, just make me comfortable. Use no antibiotics or other life saving therapies.

§ If I cannot feed myself, just leave the food for me. Do not spoon feed me or encourage me in any way to eat or drink. Do not treat dehydration with anything other than fluids offered orally, and do not try to encourage drinking beyond what I clearly desire.

§ Give me no artificial feeding or hydration of any sort. I do not want a tube inserted to administer food or hydration (no intravenous fluids).

§ If I cannot breathe for myself, I do not wish to be put on a ventilator. Oxygen is not to be administered other than the possibility of air hunger. Low levels of oxygen in the blood are not sufficient indication for the use of oxygen.

§ If my kidney’s fail, I do not want dialysis.

§ If I stop breathing or my heart stops beating, I do not want cardiopulmonary resuscitation.

§ I want no blood transfusions.

§ If I have a heart attack or a stroke, do nothing to extend my life, but do provide comfort measures.

§ I want no surgery unless it is absolutely necessary to control pain.

§ I want no x-rays, blood tests, other laboratory tests or invasive diagnostic procedures.

§ I do not want vital signs to be taken, including blood pressure and temperature measures.

§ I do not want to be treated in a hospital, but wish to be made comfortable where I reside.

Thank you for being willing to abide by these directives.

IN WITNESS WHEREOF, I do hereby declare that I sign and execute this instrument willingly, in the presence of each of the undersigned witnesses, and that I execute it as my free and voluntary act for the purposes herein expressed this ________ day of ________________, 2023.

_____________________________

We, the undersigned witnesses, each do hereby declare in the presence of the aforesaid declarant that the declarant signed and executed this instrument as a letter of instruction in the presence of each of us, that the declarant signed it willingly, that to the best of our knowledge the declarant is of sound mind and under no constraint or undue influence, and that neither of us is related to the declarant by blood or marriage, nor would either of us be entitled to any portion of the declarant’s estate on the declarant’s decease.

WITNESSES:

________________________________

________________________________

COMMONWEALTH OF MASSACHUSETTS

MIDDLESEX COUNTY

On this _______ day of _________________, 2018, before me, the undersigned notary public, personally appeared _________________________, _____________________ and ______________________ who are personally known to me - or proved to me through satisfactory evidence of identification, which was a driver’s license – to be the persons whose names are signed on the preceding or attached document, and acknowledged to me that they signed it voluntarily for its stated purpose.

_____________________________

Notary Public

My commission expires:

Copies of this request have been given to:

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