Beyond The Advanced Directive

Most people have heard of an Advanced Directive, or AD. An AD is a legal document that allows us to spell out some of our end of life wishes. Most ADs have two main functions:

1. They allow us to name an agent to make healthcare decisions on our behalf should we become incapable of doing so on our own (an attorney and/or treatment team can advise further on these circumstances).
2. They allow us to choose and indicate what kind of medical treatments we want and do not want at the end of life.
   

Reviewing an AD with your loved one is a wonderful time to talk about end of life wishes and care. This document is important, as it effectively reduces and/or eliminates confusion about these specific questions, the answers to which no one wants to have to guess.
However, the AD is limited in its scope. It only asks very specific questions about specific medical procedures such as intubation, tube feedings, and resuscitation. While responses to these questions allow individuals and families control over medical interventions, and instruct medical staff on how to proceed, the conversation about end of life wishes by no means should end with the AD. It can be much more rich.
I encourage everyone to move beyond the Advance Directive into a greater, more in depth, more purposeful conversation.
In modern America, we live in a culture of death denial that was simply not possible 150 years ago. Back then, families lived together longer, and people died at home, cared for by family. After death, the family kept their loved one at home, caring for his or her body, anointing, washing, dressing and preserving it. That was simply what was done. There had to be conversations within families about what people wanted at death because people died at home. So, what happened? Well, that’s a bigger question to be addressed in another blog post (briefly: The Civil War saw the creation of embalming and the funeral industry was born). But, the short answer is: we outsource most things now, including death, sending our dead to “professionals,” thus completing a cycle of death denial that starts with thinking death is morbid and/or something we’re not equipped to handle, and leads to ignoring death until it can’t be ignored.
I like to think about birth and death in modern America. To me, birth is the transition of spirit into a new physical form, death is the transition of spirit out of its body vessel.
When you think for a moment about birth culture versus death culture in the US, it’s kind of funny. There is an entire industry dedicated to preparation for birth; physical preparation through childbirth and parenting classes, baby showers, countless retailers selling any and everything new parents could need with lots of advertising and competitive pricing. Emotional preparation: most expectant parents dream about and plan every last detail, imagining how they want to feel, and what a Good Birth would be like.
Yet, we all die, but we don’t get coupons in the mail for coffins. and most of us don’t think about how we want to feel, make decisions about care beyond the Advance Directive, or prepare emotionally or physically. We certainly don’t consider what a Good Death would be like.
But, we can make a different choice.
I’d like you to try an exercise. Sit or lie down in a comfortable, quiet spot where you won’t be disturbed. Think about death; your own death. What are your thoughts? How do you feel? What sensations do you notice in your body?
If I asked you what a good death would be like, what would you think? Are any images coming to you? Did you ever consider having a good death? Do you think a good death is possible? Can you imagine how it would feel?
I can. I know that a good death is possible, because I have been present at good deaths.
Death is personal. It is not a cookie cutter experience, and it is fitting that we should customize it.
A simple way to start thinking about how you want to die is to consider how you like to be cared for in general. Let’s use treating a cold as an example.
When I feel a cold coming, I take immediate preventive action. I visit my acupuncturist, take herbs and supplements, go to a sauna, wear my warmest socks, drink more water than usual, diffuse essential oils, and get plenty of rest. I listen to my body. I don’t push my body, I don’t go to work, I cancel all non-essential appointments and I concentrate fully on getting better. I eat if I want to eat, I don’t if I don’t. I introduce only calming stimuli to my environment e.g. I avoid people who raise my dander, and I keep my visual and aural intake mellow, often turning to comforting favorites (“Anne of Green Gables” is my usual sick day movie of choice!). If I need help, I ask for it, and I allow people to take care of me. It feels good. Maybe you treat a cold differently! What’s good for me is good for me, not everyone. But it’s a conscious choice…and making choices is what I am trying to stress here. Not making choices is a waste of freedom and conscious thought. Making informed choices is an act of self-love.
I have very specific ideas about my death that I have shared with my loved ones. I know that even if some things change, or are not possible when it is my time, my wishes are understood and I will be honored. It feels good.
Please message me at silverwheelhealing@gmail.com to share how this exercise felt for you, and how will you want to go past the Advance Directive. I’d love to hear from you.
Sending love, light, and bright blessings today and always,
Emily