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Planning My Exit

Kathy Wilhelm

WE HAVE A MEDICAL profession apparently wedded to the notion that quantity trumps quality. That’s why, although I have no problem with being dead, I have serious concerns about the process of becoming dead. I have no wish to linger for months attached to tubes, or to disappear for years into the mists of dementia.

I have few childhood memories, and I wouldn’t swear to the accuracy of those I have. Still, one from my teens has remained with me. It was the last time I saw my maternal grandmother, then in her mid-90s and confined to a hospital bed. I remember her begging me to help her end her life. It’s possible she only meant for me to help her get out of the hospital. But either way, I was as helpless as she. My mother, on the other hand, died in her sleep in her own bed, after declaring on her 90th birthday that she was ready to go. I can only hope for the latter death. The steps I can take to avoid the former may not work, but I have to try.

First, I have appointed a health care power of attorney. The friend who agreed to serve understands and agrees with my views on end-of-life care. She will, I am sure, say “no”—loudly and persistently—if required. Second, I have a living will, also known as an advance medical directive, that specifies what treatment I do and don’t want in certain circumstances.

My lawyer prepared both documents, along with a financial power of attorney, when I updated my will. I have copies, the folks appointed in my powers of attorneys have copies, and my lawyer has copies, plus they’re stored online with Docubank. I carry Docubank’s card in my wallet. In addition, my medical records include contact information for my health care power of attorney. These documents are state-specific. If you’re a snowbird, you probably need two sets. If you’re living on the road, you should talk to your lawyer. Don’t have a lawyer? You could choose to do-it-yourself.

Third, I have a DNR—a “do not resuscitate” order—which states that efforts at cardio-pulmonary resuscitation should not be initiated. Again, this is state-specific. Mine, bright orange, carries the seal of the State of North Carolina, along with my doctor’s signature. I have one in my handbag, one in my car and one in my apartment.

Whether the DNR would be honored is, sadly, not clear. If you’re taken to a Catholic hospital, possibly not. If you’re in the operating room, possibly not. The nurse who was about to put me to sleep before eye surgery informed me, rather self-righteously, that a DNR carried no weight there. This completely baffled me. Dying on the operating table is the epitome of a good death. Why mess it up when my wishes are clear?

These precautions are for unexpected events—a car accident, a stroke. What about a disease promising a slow death? What about Parkinson’s, Lou Gehrig’s disease, dementia? The medical profession usually won’t help you. Physician-assisted suicide is legal in just 10 states, plus Washington, D.C. You have to be within six months of death, make multiple requests and be able to administer the dose yourself.

Meanwhile, the do-it-yourself methods are unattractive. I could emulate the Romans and slit my wrists, but that seems unfair to the person who finds me. I could visit Mexico in search of pharmaceuticals, if I knew which ones to ask for. Katie Englehart explores some of the options in The Inevitable.

If I have one of those diagnoses, I hope I’ll be able to take a one-way trip to Switzerland, where the right to die is not limited to citizens. It’s not an easy road, requiring multiple interviews and much paperwork, but it is certain. Amy Bloom chronicled the journey she took with her husband, after he was diagnosed with dementia, in her book In Love.

You may find this topic morbid or distasteful. But isn’t it better to think about it ahead of time, when there’s no urgency? You may say “let nature take its course,” but we have made that so difficult. Pneumonia used to be called “the old man’s friend,” but now we cure it with antibiotics. Death will not stay his hand because we pretend he doesn’t exist, and is likely to be less frightening if we acknowledge him. Articles on this topic draw anguished comments from people who watched helplessly as their loved ones died badly. Do what you can to avoid that fate.

Kathy Wilhelm, who comments on HumbleDollar as mytimetotravel, is a former software engineer. She took early retirement so she could travel extensively. Born and educated in England, Kathy has lived in North Carolina since 1975. Her previous article was Continuing Care.

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