I must be on a roll here thinking about conflict at the end of life. In light of the recent 911 call from the independent living apartments in Bakersfield and other recent things I’ve read – this issue can use much more discussion. I even posted a link to my Facebook page about it. I liked reading Charles Ornstein’s recent article in the Washington Post entitled “I thought I understood health care. Then my Mom went into the ICU.” Read it here. Ornstein’s poignant and personal account of the difficult decision faced by his family after his mother was in a coma and certain decisions had to made is very instructive. I hear frequently from clients and family members who are health professionals that their training makes these difficult decisions much easier. I am not always so sure. Some oncologists, for example, are much more focused on a patient’s quality of life at the end of the course of a long and devastating disease, while others prefer to operate in more of a “superhero” mode, vowing to never give up on a patient’s chances for recovery. There is no right or wrong here – all of these decisions are difficult, even when we have a pretty good idea about the choice and preferences our loved one has previously expressed. I think of my own experience with my parents’ deaths. My father died in March 2010 after a long bout with a combination of an undiagnosed neurodegenerative disease coupled with what was later discovered to be metastatic prostate cancer. I accompanied him to the doctor on many occasions and was his health care agent for the last nine months of his life. My mother, his wife of 59 1/2 years, worked for many years as a Registered Nurse – but this set of considerations and +decisions was a whole different ball game.
It is usually extremely difficult to talk with others about death, and this difficulty is lessened somewhat when the conversation is initiated by an older loved one who wants to make his or her wishes known. This doesn’t often happen. There are ways to start the conversation though! It only becomes more difficult in the face of a life-altering illness. I have worked with many people with terminal illnesses. It is not any easier to consider end-of-life issues even if they are more “real” in light of a life-threatening disease. Because I know how difficult it can be for a doctor to raise the issue of hospice care and associated palliative care or quality of life issues with a patient – the patient may believe that their doctor is “giving up” on them – I will often take the opportunity to discuss these issues when appropriate. I think the questions are much less threatening when you are discussing them with your lawyer as opposed to your doctor. These involve, after all, legal questions. Elder law is such a fascinating mix of and intersection of legal, medical, financial psychological and cultural questions.
I also enjoyed reading “Managing Our Miracles: Dealing with the Realities of Aging” in the latest issue of Bifocal, the publication of the ABA Commission on Law and Aging In this article, Monsignor Charles Fahey refers to “the third age” – the one that is part of human aging that is beyond human reproduction and physical strength – which has become profoundly extended in recent years. I have blogged previously about Erik Erikson’s developmental stages and his wife Joan’s extension of “The Life Cycle Completed” which included her own chapter entitled “The Ninth Stage.” I think old age and elderhood need to be examined and re-examined in our culture so that we have a more inclusive definition of what is our human “useful shelf life.” Many of the clients I see, along with assistance from their family members – do an excellent job of meeting the challenges of increased longevity. As I remind people, this new age of elderhood is something that affects us in a variety of new and sometimes surprising ways. This longevity can provide opportunities to live parts of a life that had previously been unlived, or not – depending on each of our own unique circumstances and how we find meaning in our lives. As Hermann Hesse observed:
There’s no reality except the one contained within us. That’s why so many people live an unreal life. They take images outside them for reality and never allow the world within them to assert itself.
Longevity challenges that, and we generally have no frame of reference for today’s longevity. We can create this new stage of life within ourselves and share it with our loved ones. Dementia can be a side effect of longevity for many of us or our family members or loved ones. We make meaning in our lives and others in our ability to “do” often as some kind of proof of our existence. Dementia can challenge all those beliefs and ideas about who we are, what it means to “be” simply and no longer able to “do” as we did for ourselves and for others before. This is part of the new reality of aging and longevity. More on this topic later. . . .
©Barbara Cashman www.DenverElderLaw.org