Luskin: Advance Directives

Apr 21, 2017

I learned about LaCrosse, Wisconsin, from a Planet Money episode called, The Town Where Everyone Talks About Death - a city of more than fifty thousand residents, where ninety-six per cent of them have an Advance Care Plan on file.

Of the roughly three hundred and nine million Americans who don’t live in LaCrosse, fewer than thirty percent have filed an Advance Care Plan with the National Registry. But that’s changing, at least in Windham County, where I live, because Brattleboro Area Hospice has recently launched Taking Steps Brattleboro, a county-wide initiative to help every adult resident complete and file an Advance Care Plan.

The hospital ethicist who started the initiative in LaCrosse back in 1991, did so to help families negotiate the threshold between life and death for an ailing loved one. Modern medicine sometimes makes that threshold ambiguous, and in our technological age, medical intervention may be able to keep a person breathing indefinitely. But breathing isn’t necessarily synonymous with living, or even with being alive, and in these instances a patient can’t advocate for her or himself – unless they’ve filed an Advance Directive and named an agent to act on their behalf.

That’s what an Advance Care Plan does, and I now have one of my own.

I could be in a car wreck later today, develop a fatal disease tomorrow, or live to extreme old age, but one way or another I know I’ll die – and I’d like to die a natural death.

This can be easier said than done when the medical-insurance-complex is geared toward keeping us alive for as long as we’re breathing, often preventing what’s called “an exit event” - a term that applies to someone who’s unlikely to recover from a catastrophe and offers the opportunity to die of natural causes without further medical interference.

If I’m incapacitated beyond cure, this is how I want to go. And my Advance Care plan explains my wishes and names those I authorize to make this decision if I can’t. I’ve had some wonderful conversations with my husband, children and youngest brother, who all know I’d choose death over medical limbo.

Talking about dying with them was funny and poignant and not at all morbid. Turns out that how I want to die is really about how I want to live.