SPECIAL FROM Next Avenue
By Jane Gross
When we designate a health care proxy to speak for us in an emergency, a family member may not always be the best choice
Advance directives are in the news today because of a confounding recent case at a senior residence in Bakersfield, Calif., where 87-year-old Lorraine Bayless died while a 911 dispatcher begged an unwilling staffer to perform cardio-pulmonary resuscitation. As we've learned more about the incident, two somewhat contradictory facts have become clear: The woman's family had no complaints about her care because, they say, she wanted to die naturally -- but she apparently had no end-of-life documents stating that wish.
It begs the question of why any 87-year-old -- or any 40-, 50- or 60-year-old, for that matter -- would not have taken the simple steps to complete an advance directive, the vital legal instrument that does not guarantee, but surely increases, the odds that one will die according to one's wishes.
(MORE: After Glenwood Gardens: What Would Your Loved One's Residence Have Done?)
As it happens, very few of us have taken those steps.
About 30 percent of American adults have advance directives in order, according to recent studies by the Pew Research Center, the Johns Hopkins Bloomberg School of Public Health and others. People living in nursing homes, unsurprisingly, are the most likely to have enumerated their wishes. Younger adults are the least likely to have done so, even though youth is no protection against catastrophic accidents.
A Right and a Responsibility
In the simplest terms, as stipulated by Congress in the 1990 Patient Self-Determination Act, we have access to legal tools (which can now be easily completed online) allowing us to state our preferences about medical care to family, friends and health care professionals in the event we are unable to make those decisions. The two main types of advance directives are living wills and medical power of attorney documents, better known as health care proxies.
A living will lays out what kind of life-sustaining care -- CPR, ventilators, tube feeding -- someone would or would not like to receive in the event they are unable to speak for themselves. A health care proxy designates a trusted person to see to it that those wishes are carried out. Most experts consider the proxy to be far more crucial than the living will, as it is all but impossible to itemize each and every procedure that might be relevant as medical technology advances, or to adjust what one wants and doesn't want over what could be decades.
(MORE: How Strong Is Your Living Will?)
For example, if I were in my 40s and my prognosis was a return to health, I would want to breathe or be fed artificially for a limited amount of time. But I would not want to have the same measures taken at 90, regardless of my prognosis, as my quality of life would likely already be compromised and my remaining lifespan brief, its trajectory headed in only one direction. The resources spent keeping me alive would be better used elsewhere.
Who's Your Proxy?
Your proxy, carefully chosen and privy to your overall philosophy, is likely to have the responsibility of making decisions not explicit in your living will, a daunting legal and ethical responsibility. In most cases, people designate a close family member, but I believe an argument can be made against the assumption that a relative is always the right choice. More people -- even those with wonderful children, spouses or siblings -- might do themselves and their families a favor by thinking out of the box.
My proxy is a dear and trusted friend several years my junior who lives close by, although we go long periods of time without seeing each other because of very different life and work situations. Since she agreed to be my proxy years ago, I've asked her repeatedly if she found it an unreasonable burden, especially since one of her children is disabled and she has more than enough on her plate. Each time she assures me that it's her privilege, I'm grateful anew.
This role I've given her has even come to be a source of jokes between us, a sure sign that I made the right choice. Before I had complicated eye surgery recently, I told her that my brother, Michael, would be accompanying me. She advised me to be sure he had her phone number lest anybody needed to pull the plug. "Kineahora," she added, a Yiddish expression meant to ward off the evil eye. My mother used to say that, too, with superstition and then thanks when fortune smiled.
So why my friend and not my brother? Because she is level-headed, wise and calm in a crisis, of which she has known many. Her love for me is unconditional but would not take her to sentimental places. She would grieve for me but not keep me alive for her sake or because letting a loved one go is one of the hardest things a human being is ever asked to do. If medical staff tried to bully her, they would sorely regret it. She would use logic, then sweet persuasion, trickery and, if necessary, physical force to see that I got what I wanted. Not being able to watch her in this role would be the worst part of being unconscious.
(MORE: Letting Go of Entrenched Family Roles)
My brother is also unusually able in a crisis; he's all business. During my mother's last years, when there were emergencies, I was always a basket case for the first hour or so. Michael carried the ball during those windows. Our skills were different, but our ability to do what needed to be done was pretty much equal -- until she was near death.
I was way better at that point, and suspect he would be the first to admit it. There are many explanations why. My portfolio as a reporter had given me many opportunities to witness dying from a front row seat. I had also been a primary caregiver before, some years back, for a colleague and friend who died of brain cancer.
(MORE: The Perils of Aging Alone)
But more significant than any of that is the fact that all his life Michael had been far more attached to my mother than I was, though our relationship flowered in her old age. No proxy ever had to be employed for her because she remained cognitively intact until the very end, but he found her final days unbearable to witness. We both wanted her to be able to die as she chose, but I was the one who advocated to make it possible. I was the one who stayed with her through her dying. As her proxy, had I needed to make decisions that would have ended her life, I would have made them. I miss her terribly, but do not wish she had lived longer in the state she was in.
Michael has told me many times that he is grateful those decisions would have been mine. I suspect he'd have had great difficulty making them, which my mother may well have suspected and thus assigned me the proxy. It surely wasn't because I was her "favorite.'' It was probably because I wasn't.
And now, I neither want Michael to have to suffer what for him might be the agony of doing this for me, nor do I want my fate in his hands. It is not that I don't love him, or him me. But my dear friend of the kineahoras does not carry the baggage of family. She'll row me across the river from this life to the next, if she must, both wisely and more easily than kin.
Read more on Next Avenue
1. Make Bad Dietary Choices
Over the years, there's been a lot of debate related to diet and longevity. But most experts agree that a <a href="http://www.huffingtonpost.com/jay-williams-phd/best-diets_b_2268460.html" target="_blank">diet low in sugar and refined carbohydrates is best</a>. And some studies show that eating a traditional <a href="http://journals.cambridge.org/download.php?file=%2FBJN%2FBJN84_S2%2FS0007114500002701a.pdf&code=a4a2995aa69a094808c095f29250a990" target="_blank">Mediterranean diet</a> can add years to your life.
2. Never Check Your Cholesterol
Just like high blood pressure, <a href="http://www.webmd.com/heart-disease/guide/heart-disease-lower-cholesterol-risk" target="_blank">high cholesterol can also increase your risk of heart disease</a> and stroke. Therefore it's a good idea to have your cholesterol checked to see whether you need to undergo certain lifestyle changes or even possibly take some kind of cholesterol-lowering medication. For more information about cholesterol and saturated fats, go <a href="http://www.hsph.harvard.edu/nutritionsource/fats-full-story/" target="_blank">here.</a> Eating certain foods, such as beans, which are rich in fiber and antioxidants, can help lower cholesterol.
3. Mix Alcohol And Prescription Or Illicit Drugs
<a href="http://www.huffingtonpost.com/ann-brenoff/whitney-houston-prescription-drugs_b_1280439.html" target="_hplink">Even drinking wine with dinner and then taking prescription sleep aides can be a lethal combination</a>. A U.S. Department of Health and Human Services study found 5.8 percent of people age 50 to 59 used illicit drugs in 2010, up from 2.7 percent in 2002.
4. Never Check For Diabetes
The number of Americans with <a href="http://www.diabetes.org/" target="_hplink">Type 2 diabetes</a> is expected to rise from 30 million today to 46 million by 2030, when one of every four boomers -- 14 million -- will be living with this chronic disease, according to the National Center for Chronic Disease Prevention and Health Promotion. <br /> <br />Untreated diabetes can lead to blindness, amputations and clogged arteries that can cause heart attacks and strokes. The test to determine whether you are diabetic is a simple blood test; you should remind your doctor to include it in your annual physical.
5. Pack On The Pounds
More than one out of every three boomers -- more than 21 million -- will be considered obese by 2030. Already, we are the demographic with the highest and fastest-growing rate of obesity. As we age, our metabolism slows down and we burn fewer calories -- if we don't alter our eating and exercise patterns, weight gain is inevitable. Obesity can lead to high blood pressure, heart disease, and a host of other life-threatening ailments. <a href="http://www.huffingtonpost.com/ann-brenoff/the-dieting-10-percent-club-losing-weight-after-50_b_1440729.html" target="_hplink">Losing just 10 percent of your body weight</a> has health benefits, so consider that as a goal.
6. Ignore The Signs Of A Heart Attack
No chest pain doesn't mean no heart attack. <a href="http://www.webmd.com/heart-disease/features/her-guide-to-a-heart-attack" target="_hplink">Women having heart attacks</a> frequently report experiencing a feeling of indigestion and extreme fatigue, while some men say they feel a fullness or a squeezing pain in the center of the chest, which may spread to the neck, shoulder or jaw. When a diabetic has a heart attack, the pain is often displaced to other areas such as the lower back.
7. Get Little Sleep
Try as you might, you just can't stay asleep, right? You pass out before "60 Minutes" is over, but then wake up around midnight and count sheep until the alarm goes off. If that sounds like you, you aren't alone. The U.S. Centers for Disease Control and Prevention says that <a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5842a2.htm" target="_hplink">boomers report not getting enough sleep between one and 13 nights each month</a>. Is it life-threatening? In itself, no. But as soon as you slip behind the wheel bleary-eyed, you are putting yourself and others at risk. Your reflexes are slower, you pay less attention and you could become one of the more than 100,000 Americans who fall asleep at the wheel and crash each year. And the <a href="http://drowsydriving.org/about/facts-and-stats/" target="_hplink">National Highway Traffic Safety Administration</a> says that's a conservative estimate, by the way. Driver fatigue results in an estimated 1,550 deaths, 71,000 injuries and $12.5 billion in monetary losses.
8. Avoid Exercise
AARP says the minimum you need to stay healthy are muscle-strengthening exercises twice a week, plus 2.5 hours a week of moderate activity like walking or 75 minutes a week of a more intense activity like jogging. Exercise is also good for your memory: Just one year of <a href="http://www.aarp.org/health/brain-health/info-02-2011/keep_your_memory_strong_by_walking.html" target="_hplink">walking three times a week can increase the size of the hippocampus</a>, the part of the brain that's key to memory.
9. Carry The World's Burdens On Your Shoulders
We're talking about stress with a capital S. Boomers are the sandwich generation, caught in the middle of caring for our parents and our children. We were deeply affected by the recession and <a href="http://www.huffingtonpost.com/ann-brenoff/midlife-crisis-depression-is-ok-the-new-good_b_1470958.html" target="_hplink">boomers have the highest rates of depression</a> by age demographic. Unless we unload, we are going to implode.
10. Carry A Beer Belly And A Caboose
It isn't just our extra weight; it's where we carry it. An excess of visceral fat causes our abdomens to protrude excessively. We call it a "pot belly" or "beer belly" or if the visceral fat is on our hips and buttocks, we say we are "apple shaped." Cute names aside, scientists now say that body fat, instead of body weight, is the key to evaluating obesity. And guess what? It's all bad.
11. Continue To Smoke
<a href="http://www.gallup.com/poll/128183/smoking-age-baby-boomer-bulge.aspx" target="_hplink">Gallup found that baby boomers between the ages of 44 and 54 reported higher levels of smoking</a> than those immediately younger or those who are older. Hard to imagine that they haven't gotten the word yet about the risks cigarettes carry.