Letter to the editor.
This is a letter to the editor from Lucia Jander, M.D., Medical Director at Hospicare & Palliative Care Services. To submit opinion letters, please review our letters policy here and submit them to Managing Editor Thomas Giery Pudney at tgpudney@ithacavoice.com.

End-of-life. Dying. Death. These words make people so uncomfortable that we often soften them.  We talk about loved ones who “passed away,” or “lost a battle,” or “went to heaven.”

There are many reasons to view COVID-19 as a dark time for our community and our world. It is. If there is a silver lining to a pandemic, it is that it makes people confront their own mortality, think about their wishes, and – I hope – become a little more comfortable with death as a part of life.  This is a good time to open the door to those conversations with loved ones.

In hospice, every patient and family works with staff to develop a personalized care plan. Each patient shares with us their preferences for physical, emotional, social, and spiritual care.  Some patients may desire music therapy; others may want help making amends with their family. Just as every person is unique, there is no “one size fits all” approach to end-of-life care.

How do you imagine your end-of-life experience? What medical or life-sustaining care do you want?
Who are the family and friends who will be most impacted by your death? 
What do you want your legacy to be? 

You don’t need to be sick or in crisis to have these conversations. My advice to my patients is to spend time thinking about your desires, and what you want to articulate to your loved ones. Think of this process as creating peace of mind for yourself, and offering a gift to the people who love you most.

Here are some resources to get started:

  • A Health Care Proxy legally designates a person who will make health care decisions if you are unable to make them yourself. Choosing a health care proxy is the most important thing you can do. Because it is difficult to know all the choices that will need to be made, it is important to appoint someone you trust and who knows your core values. Be sure that every one of your medical providers has a copy of this proxy, keep a copy at home, and send a copy to your attorney, if you have one. It’s also a good idea to think about naming an alternate proxy, in the event your primary proxy can’t perform their duties; make sure both individuals are unified around you and your expressed desires.
  • A Living Will is not a legal document, but it is something that you can provide to your loved ones and your health care proxy to explain your decisions about your end of life.
  • A Medical Orders for Life-Sustaining Treatment (MOLST) form outlines your wishes for the end of life in the event you cannot make this decision yourself. If you do not have a Health Care Proxy, this document will guide medical decisions.
  • A Do Not Resuscitate Order (DNR) determines what life-sustaining measures, if any, you would like if your heart has stopped beating and you are not breathing. While a DNR can stand alone, it is also a part of the more comprehensive MOLST form.
  • A Durable Power of Attorney names someone to make financial decisions when you can no longer do so.  If finances are complicated or there are exceptions to the use of your money, this document can be drawn up by a lawyer.
  • A will indicates how your assets and estate will be distributed upon death.  The person you name within your will as the executor is responsible for ensuring your wishes are met.  Your will may also specify arrangements for the care of minors, gifts to loved ones or favorite charities, and funeral and/or burial arrangements
  • A living trust provides instructions about the person’s estate and appoints someone, called the trustee, to hold title to property and funds for the beneficiaries. A living trust can provide a detailed plan for property disposition.
  • If you’d like to be an organ donor, you can carry an organ donation card in your wallet. Also, consider putting together important documents so that they are easy to access in a time of stress or uncertainty: bank account numbers; insurance policies; the mortgage, deed, or lease for your residence; Internet account numbers and passwords; and phone numbers for family members, your lawyer, doctor, financial planner, and pastor or priest.

Dying is not something we can – or should soften. Death is a part of life, and planning for it can make all the difference to the emotional health of those you leave behind.

Hospicare is here to support residents of Cortland and Tompkins Counties, and we speak to individuals and groups about the importance of end-of-life planning. If you need more information or help connecting to specific resources, please contact us at info@hospicare.org or 607-272-0212.

Lucia Jander, M.D., Medical Director at Hospicare & Palliative Care Services

Ithaca