Well, it only took me about forty years. Better late than never, as the saying goes.
Tomorrow I'm taking an Advance Directive to my family physician when I go for my annual physical exam, so it can be made part of my medical record. I've had this booklet from Oregon Health Decisions sitting at the bottom of a pile of papers in my office for a year, at least.
This booklet replaced a previous booklet that I lost or threw away.
It's kind of strange that I've been so reluctant to make my end-of-life wishes known, since I was the first executive director of Oregon Health Decisions in the 1980s, when this pioneering citizen-based bioethics organization got off the ground after a brilliant psychiatrist, Ralph Crawshaw, worked to get it going with the help of me and many other Oregonians.
In fact, I wrote the first advance directive booklet published by Oregon Health Decisions. Since back then I was in my 30s, whereas now I'm 72, it made sense that I'd put off filling out an advance directive for quite a while.
And I readily admit that as I grew older, I did my best to avoid thinking about the not-so-cheery prospect -- a certainty, actually -- of my eventual death.No longer. Yes, I'm still pretty damn healthy, though I have a couple of health problems. Most people do at my age.
I just felt it was time to do the Advance Directive thing. Probably the Covid crisis helped spur me to do this, since the prospect of being kept alive via a feeding tube, ventilator, or whatever when there is no hope of recovery isn't an appealing notion.
What gave me the most trouble was deciding whether to complete the brightly colored POLST form that had been inserted in the booklet. That stands for Physician Orders for Life-Sustaining Treatment. My wife, Laurel, has a POLST even though she also is healthy with just a few relatively minor medical issues.
Laurel is convinced that she doesn't want CPR, should this ever be a consideration. I believe Laurel is correct that the view of CPR in movies and TV shows, where a person recovers nicely after getting this potentially live-saving procedure, often doesn't reflect reality. For example, one CPR web site says:
Overall, all of these side effects mean that, if a person does survive CPR, their long-term health could suffer and they may be alive, but it is possible that their overall health and quality of life is significantly affected. Additionally, the psychological ramifications of a near-death experience can greatly affect a survivor, leading to anxiety, stress and depression, among other psychological conditions.
A POLST appears to be the only way to make sure that you don't get CPR, since a POLST becomes part of a registry available to medical professionals, and you can carry a POLST card with you.
On the other hand, the POLST form says that it "is usually for persons with serious illness or frailty." And POLST.org has this FAQ about which patients should be offered a POLST form.
The POLST form is not for everyone; a POLST form is appropriate for patients who are considered to be at risk for a life-threatening clinical event because they have a serious life-limiting medical condition, which may include advanced frailty. For these patients, their current health status indicates the need for standing medical orders for emergent or future medical care.
Also, these are the patients at the greatest risk of having a medical emergency but who may not want our standard of care (standard of care currently being that everything possible to attempt to save someone's life must be done). For healthy patients, an advance directive is an appropriate tool for making future end-of-life care wishes known to loved ones.
So I decided to complete an Advance Directive, but not a POLST. I can always go the POLST route later, should this seem like a good thing for me to do.