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Last Thoughts Do Count

Some of the greatest moments in life in ancient times were, ironically, the moments just before death. All the children would gather at the bedside and the matriarch or patriarch would, if possible, bestow blessings (or curses) on each of his or her offspring. The dying would be tended day and night until the end. And when the end came, it would be marked with a terrific outpouring of grief. It satisfied both the dying person and the family. And it was planned for and considered a part of life.

Today, we're still dying, of course, but dying has become a separate part of life. It's taboo, as if we or our managed care systems have failed when we die. We're more likely to die alone in a hospital bed, or hooked up to machines which make it impossible to communicate with our loved ones. Even though the process of dying today is still different, the needs of the dying and their families and friends are natural and remain the same as in ancient times.

What the dying want

A recent study has led Florida attorney Jim Towney to devise a living will (a signed document specifying the types of medical treatment you want or don't want) called Five Wishes. According to Don Colburn of the Washington Post, the document is "written in reader-friendly language [and] is aimed at prompting people to talk with their families and doctors about something most choose not to talk about: their own death." This document has been adapted for national distribution in a campaign backed by the American Bar Association; it conforms to the legal requirements of 33 states. An estimated three out of four Americans adults have not filled out a living will of any kind, let alone talked with their families about what they want at their death.

The first two "wishes" in the document refer mainly to legal and medical issues, such as the use of life-prolonging treatment. The number one fear of patients, according to researchers, is the fear of lingering on--being in a vegetative state or residing in a body that has no hope of recovering. The remaining wishes involve more personal concerns, such as "pain relief, fear of being alone at the moment of death and thoughts about what should be included in the memorial service," writes Colburn.

What you can do

1. As uncomfortable as it may be, start discussing your last wishes now with your family. Studies have shown that doctors will often ignore a patient's living will unless the family feels the same way and urges the physician's compliance.

2. Expressing your wishes about not prolonging your life needlessly--and hearing those of your other family members--will alleviate the guilt that often follows if someone must make the decision to turn off life-support systems.

3. On the other hand, don't be pressured into signing a document that says to not use heroic measures. There are many people who want to hang on as long as possible. If that's your situation, make that known to your doctor and family.

4. Know the difference between a living will and a power of attorney. A living will is a signed document specifying the treatment you do or don't want at the end of your life, especially if you can't make the decision at the time. A medical power of attorney is a document in which you appoint someone to make decisions about your medical care should you not be able to.

5. Insist on pain control. With the medications available today, no one need die an excruciating death from illness. Make it clear to your family and doctor that you want your last days to be free from pain.

No one can guarantee you a wonderful death, but at least it can be consistent with your wishes--just as other aspects of the life process.

For more information

You can retrieve "Five Wishes" free on the Internet at www.agingwithdignity.org. Also visit http://www.compassionandchoices.org/.

Ilene Springer

Ilene Springer is a freelance writer based in Dover, New Hampshire.

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