I have a question for you. You are more than welcome to answer it, for yourself—in fact, you probably should. But really, I’m giving you this question as a gift to use as a tool with your clients, because this is one of the most important questions you can ask when it comes to advance care planning.
The question is, What makes life worth living for you?
When people start thinking about their end of life directives, questions about what they do or do not want can be daunting. What kind of life support do you find acceptable, or desirable? Respirators? Feeding tubes? Do you want the doctors to try every possible option or would you rather let nature take its course without interference? For most people, the answer to all of those little questions will be “Well, it depends.”
Exactly what it will depend on will be different for each person, and it can get confusing and complicated to answer all those questions individually. But if you start with what makes life worth living, you can get some powerful insights into how to answer the nitty-gritty stuff.
For one person, the answer might be that they want to keep living for as long as they can still eat ice cream and watch television. Most illnesses will allow you to do both of those things for a pretty long time, no matter how sick you get, so life-saving measures which might mean keeping them alive at the cost of their mobility or cognitive function would be worthwhile, in their mind.
Another person might tell you they wouldn’t want to live if they couldn’t visit and share stories with their families. In this case, they might prefer an AND (Allow Natural Death) order over treatments which would keep them alive, but dependent on machines to stay that way. A third person might tell you they have no interest in living anywhere but in their own home, preferring perhaps a shorter life in the place where they are comfortable to the extra months or years they might get from being cared for in a facility.
Some people will know the answer the moment they are asked the question. Others will need time to think. Everyone has the option of changing their answer at any time, as long as they are still competent to change it. It’s a big, tough question, but when a person has an answer, and when they can give that answer to their families and the people who may end up making medical decisions for them at the end of their life, it is a much better guide for those decisions than a simple list of machines and procedures that are and are not acceptable.
Part of end of life care is helping people maintain the highest possible quality of life until the very end. The best way to know what your client considers to be worth living for is simply to ask them. Find out what they love and what they live for, and you can probably figure out the other side of the coin—what would make life unbearable. And now, with one question, you have a blueprint for an advanced medical directive. It might not be an easy question, but the answer will make everything else a lot more simple.
