While most of us know we will have to die someday, we may practice denial or avoid thinking about the prospect all together.
Medical advances can prolong life and create situations where treatments are given when not chosen by the patient, resulting in unnecessary suffering. Without proper planning, having your say at the end of your life is not guaranteed. Taking the time now to plan for the end of life helps ensure that your wishes are carried out.
The first step is to decide the level of treatment you may want if you are critically ill with little chance of recovery. How aggressive do you want the doctors to be in prolonging your life under such circumstances, particularly if you are experienci4g pain and suffering?
It is essential to have a conversation with family members or friends and make your wishes known to them.
The next step is to designate a medical proxy who has the legal authority to make treatment decisions for you if you become physically or mentally unable to make those decisions for yourself. A medical proxy can be a family member or a close friend who knows what you would want done under different medical circumstances.
Preparing an advanced directive is another important part of end-of-life planning. This is a legal document that outlines the treatments you do or don’t want when you are terminally or critically ill with little chance of recovery. Should something happen to your health that limits your capacity to communicate with your medical providers, your advanced directive outlines exactly how you wish to be cared for.
These advanced directives should be given to your proxy, your doctor, your lawyer, and added to your medical records.
Thorough end-of-life planning should also consider options around palliative care and hospice. Palliative care is a specialty in medicine dealing with pain control and patient comfort on multiple levels. It can relieve suffering at the end of life or for people with a chronic illness.
Hospice involves palliative care of a terminally ill patient that focuses on the physical, emotional, social and spiritual needs of the patient. The aim of hospice is to provide a comfortable death for the patient, while also supporting one’s family and friends. Asking for palliative care and hospice, when indicated, can be part of an advanced directive.
For members of the LGBT community, certain factors work against planning for a good death. Many LGBT people have no children or family and often live alone. This situation lessens the incentive to have the conversation about end-of-life choices. But it also makes it even more important to have a medical proxy.
Additionally, if one is partnered but not married, having the partner become that legal medical proxy is essential. One should have a lawyer to make these arrangements and document the choices of the advanced directives.
Finally, there may be a certain distrust of the medical establishment by LGBT people because of past discriminatory experiences. This situation can contribute to the avoidance of end-of-life decision-making.
Donald M. Friedman, M.D., is an adjunct faculty member at Sidney Kimmel Medical College. He is a volunteer on the Program Committee of the LGBT Elder Initiative.