Sunday 9 March 2014

Living Willing

There aren't many advantages to living 40km from your place of work without any available public transport.  One is that it is not 130km from work,  Another is that it gives an opportunity to listen to the car radio and catch up on events outside the county.  For a family without television and which doesn't 'take' any newspapers, this is a lifeline to the rest of humanity.  I tend to listen to Newstalk-FM in the morning as Ivan Yates and Chris Donoghue slag each other off and get opinionated about events.  They read the newspapers and the press-releases for copy and often interview somebody to give them a chance to be famous for fifteen minutes.  A Living Will a.k.a Advanced Health Care Directive is a document that endeavours to clarify your options and opinions concerning 'end of life issues".  Such documents have, at the moment, no legal standing in Ireland.  They are in the news because there is a movement to clarify the status of such clarifying papers.

I used to think such matters were easy.  I've already asked Dau.II, who can be a cold-blooded pragmatist, at the appropriate time, to hold a pillow over my wizened face until my heels stop drumming on the bed.  She, like Barkis, is willing, but there are two problems a) the appropriate time and b) the necessity to involve a confederate.  We are absurdly caught up with the sanctity of life in Ireland, so that "It is a criminal offence to aid, abet, encourage or procure the suicide of another person." Dau.II would probably get banged up in chokey for helping to off her father, as the case of Marie Fleming made clear; although in The End she died before needing help from her husband..  A lot of this was explained on Newstalk last week by Patricia T. Rickard-Clarke, the Law Reform Commissioner, who made clear that you can refuse certain interventions much more easily/legally/acceptably than you can request others.

But what was more interesting was to be forced to think a bit about when and under what circumstances fully-cognisant me could imagine severely-impaired me welcoming quietus. This conversation was helped along a lot by a PDF that was generated a few years ago by the Irish Council for Bioethics (of all people!), but which doesn't appear to be on-line anymore.  A committee can work very well at such tasks because the anecdotes and experience of the several individuals on the committee come together as a wide context than a single lifetime can encompass and thus become data.  The following list from that PDF is prefixed by "I do/don't want":
  • cardio-pulmonary resuscitation (CPR) 
  • artificial ventilation
  • artificial feeding by tube or drip
  • antibiotics
  • blood or blood products
  • kidney dialysis
  • surgery or invasive diagnostic tests
  • any new treatment without discussion with my Healthcare Proxy (HP).
I can happily refuse all of these, but you might know a case of, say, dialysis where this allows someone to live on with dignity and minimised discomfort for months or years. For example, CPR, from what I hear, can easily break a rib, especially if weak from, say, osteoporosis; and has a negligible chance of working.  You may want to trade a broken rib and exquisitely painful breathing for a few more days of life. I don't. You are strongly recommended to discuss your wishes with your GP, s/he's more likely to be beside the bedside at the relevant time.  But also, you are recommended to designate in writing, and talk deeply with, a person (Healthcare Proxy - HP) who will make the decisions on your behalf when you are no longer capable of doing so. I written about the end of my friend-and-mentor Lynn Margulis whose daughter, as HP, had to fight for the right of her mother to die.

It's also important to sort out a will (I give my second best tea-pot to Cousin Maria) as soon as you have any assets at all, but we are all agreed that you can't take that with you when you go.  So it is more important for self-interest to make sure your last days/weeks above ground are the best that you can hope for. Me, and it's all about me, I don't want to finish up neglected in the corner of a ward as the puddle of my own leakings ferments into open sores.

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