planneddeath

A Gentleman’s Guide to Telling Everyone How You Want to Die

The other really uncomfortable talk

On June 8, 1948, Saskatchewan farmer Cecil George Harris fell off his tractor and became pinned beneath it. Fearing he might not survive, he used his pocket knife and his remaining strength to carve a will into the side of the tractor as it crushed his lower body into dust.

“In case I die in this mess I leave all to the wife,” he wrote.

Spoiler alert — he died.

Afterward, his tractor will held up in court and has since been immortalized as a bizarre and entertaining example of how it’s never too late to get your end-of-life affairs in order. However, while Harris’ demise gets points for memorability, there’s also something to be said for getting your affairs in order with a bit more lead time than as you lay dying under a tractor.

Recent advances in modern medicine have made this easier than ever. Thanks to life-saving procedures like cardiac defibrillation and a doctor’s ability to suspend the dying process with ventilators and feeding tubes, patients and their families now have the option to control certain aspects of when and how they die. Resuscitation, hospice care, intubations, alternative burials… the options are endless.

Part of harnessing such newfound control, of course, involves telling other people what your end-of-life wishes are. Being open about these things enables you to effectuate your wishes regarding the kind of care you desire — not only do you receive the treatment you want while avoiding interventions you’d hope to forego (like being kept alive on a ventilator for 42 years), but your family members gain the peace of mind of knowing that they acted in accordance your wishes.

Here then is how to talk about your own death and put your plans into action…

Where to Start

When we ask ourselves how we want to die, we tend to envision the cause of our death — shark attack; lighting strike; heart attack during sex. Obviously, we can’t always control the cause our demise, but thanks to modern medicine and right-to-die laws, we can design the response to it. Doing so is called advance-care planning, and it involves detailing the type of end-of-life care and burial you wish to receive so it’s easier for you and your loved ones when the time comes to join David Bowie in space-heaven.

The first step toward advance-care planning is to ask yourself some key questions. For example…

  • Do you want to die at home?
  • How important is it to be with your family?
  • Do you want to live if you can’t feed, clothe and bathe yourself?
  • Is being a financial or physical burden to your family something you can stomach?
  • Do you want a spiritual or religious advocate to be by your side?
  • Should someone bring your pet in to say goodbye?
  • Who do you want making health-care decisions for you in case you can’t make them yourself?

It’s also good to think about what medical interventions you’d be willing to accept to keep you alive. In other words, what’s the lowest quality of life you think is worth living? Embedded in this question are things like pain management, personal grooming and bathing instructions, and whether or not you’re okay with being kept on life support in a coma. Basically, under what conditions is it okay to pull the proverbial plug?

Next: What about your body? Once you pass on, how would you like to be memorialized? Do you want to be buried, cremated or flung into deep space courtesy of Elon Musk’s SpaceX rocket? What about being propped upright in your favorite chair with a lit cigarette and a cold can of beer in your hands? Think about the type of burial that most appeals to you and write down any specifics that would help your surviving loved ones carry out your wishes. Particularly helpful details include where you want your remains to ultimately rest, who should have access to them and what you’d like your service to be like.

Making Things Official

This will involve putting down on paper your perfect earthly exit. In particular, an advance directive is a legal document you fill out while you’re lucid and healthy that outlines the end-of-life care and burial you want to receive. In the event you’re too incapacitated to relay these wishes yourself — say you’re in a coma or have severe brain damage — it acts as your legal stand-in, providing instructions to medical professionals and family members about what steps to take and when. You can update or modify these steps at any time so long as you’re capacitated.

According to bioethicist Jacob M. Appel, advance directives take an enormous amount of stress off your family and medical caretakers. “If you don’t have an advance directive and family can’t agree on a treatment plan, the controversy can cause unnecessary strife and even end up in court,” he says, citing the cases of Karen Ann Quinlan, 21, and Nancy Cruzan, 23, two young women in persistent vegetative states whose families had to fight long, brutal legal battles in order to take them off life support.

There are a few types of advance directives. One, called a living will, provides instructions for medical professionals and family members regarding end-of-life treatment and care. Another type designates a “health-care proxy” or “power of attorney,” which authorizes someone else to make health-care and burial decisions on your behalf.

Living wills and health-care proxies are often combined into a single document under an umbrella title — the aforementioned “advance directive.” (In other words, they’re separate pieces of what can also be a single entity.) Some online services like Five Wishes, which I highly recommend, offer a simple, straightforward combo deal that’s valid in 42 states. Other states (I see you, Indiana) require these two forms be filed separately. To find out what your state’s requirements are, go here.

According to the 1991 Patient Self-Determination Act, certain hospitals, nursing homes and hospice providers are required by state law to give adult patients information about their rights to make advance directives. However, because individual physicians and private clinics aren’t required to give you the same information, many people don’t know they have the legal right to fill one out, or even what they are, which explains the relatively small proportion of people who actually have one. That is, according to a 2012 survey by the California HealthCare Foundation, only 23 percent of people have put their end-of-life wishes in writing.

Barack Obama has one though, so you know it’s good.

Why Advance Directives Are Important at Any Age — No Matter How Young You Are

It’s morbid to say, but death can come at any time, to anyone, for any reason. It’s because of this that filling out an advance directive sooner rather than later is so important. If you don’t do it now (or you know, sometime this week), you might not get the chance to before it’s too late.

Beyond that, filling out an advance directive is also just good citizenship. Vast sums of taxpayer dollars and personal funds are spent on keeping hospitalized patients with no chance of recovery alive on life support, many of whom will never regain consciousness. Now, some of these patients want to be kept alive for religious, philosophical or personal reasons, but according to Appel, many others prefer not to be maintained in such a state. In fact, studies show that 70 to 95 percent of people would rather refuse expensive, aggressive life-sustaining treatments than have their lives prolonged in poor-prognosis states.  

How much urgency that strikes into your still-beating heart is up to you, but it’s safe to say filling out an advance directive now — when you’re young and/or healthy — is the proactive way to avoid unnecessary pain and expense, which is why Appel thinks they should be mandatory.

The People Who Can Help You Die

Filling out an advance directive is a quick-and-easy procedure that takes less time than a South Park episode (or blow job, apparently). They can be completed in person with a doctor, or online, in about 10-15 minutes. Here’s a little step-by-step:

  1. Fill out your state’s living will or advance directive form.
  2. Indicate your end-of-life health-care decisions and burial wishes.
  3. Sign the document — it becomes official and actionable once you do. However, to make it more legally persuasive than it already is, you might want to consider getting a witness to countersign the document or having it notarized.
  4. Keep meticulous track of where it is so you can update it if need be as well as who has a copy of it (ideally someone close to you who you trust to carry out your requests). Liane Pedersen Gallegos, a professor of sociology who teaches a class on death and dying at the University of Colorado, Boulder, suggests storing it somewhere other than a safety deposit box or a safe — unless you give out your lock combinations like floss at the dentist, no one’s going to be able to get in there to find it. Keeping a photo of it on your phone so you always have access to it is a much better option. You can update it online wherever you filled it out, too.

Gallegos, however, says posting your end-of-life and burial wishes on social media is an iffy idea at best. Because of the impulsive, banal and often fake nature of social media, your wishes might not be taken seriously. Social media accounts are also prone to hacking, so from your followers’ points-of-view, there’s no real guarantee your 140-character diatribe about being taken off life support if Drake’s next album bombs will be honored.

If you’re dying (pun more or less unavoidable) to spew your healthcare and burial wishes on your digital friends, posting your signed advance directive is a better option. Your real-life friends and family, though, would probably benefit from an in-person conversation about such things.

The ‘Here’s How I Want to Die’ Talk

Discussing the finer points of your own death is a reminder you’re not immortal, a reality that can be hard for others to face, especially if you’re young and reasonably healthy. Maybe that’s why 90 percent of people say it’s “extremely important” to make sure their families aren’t burdened by tough decisions around their death, but only 27 percent have taken the steps to do so. One reason for this is that we think we already know our loved one’s end-of-life wishes, but as research suggests, that’s not actually the case.

It’s why Appel urges people to have these conversations with their loved ones while they’re young, healthy and fully able to communicate their dying wishes. Otherwise, he says, the distress of your illness or injury can make it harder for them to hear and absorb your words. He also recommends making the topic of your own death part of an ongoing dialog as opposed to a one-off conversation. Because your care goals may evolve with age and circumstance, it’s good to communicate regularly with loved ones and health-care proxies so your wishes are honored. That doesn’t mean you have to talk about ventilators every time you see your next-of-kin, but creating an open dialog about it can solidify your wants in their minds.

Likewise, because death is a delicate topic for some, Gallegos recommends notifying your friends and family that you want to have this conversation with them before you drop the “I’ve made it so you can legally decide whether I live or die!” bomb on them. Only then schedule a time to talk about it so you can come prepared, and they know what they’re getting into.

If you need help broaching this topic with your family and friends, The Conversation Project has an excellent worksheet that can help you figure out what to say and plot out your wishes.

It’s a deadly two-for-one.