Advance Health Care Directives

Over the last few months, I've had a growing awareness that as a seriously ill person, I should have some kind of documentation in place about my wishes should things take a turn for the worse. Really, every adult should, and I realize now that I at least should have done it prior to giving birth - but as a young, healthy person, it really just wasn't part of my consciousness.

Until I started looking into it, I was pretty hazy about what the different types of documents were and what the terminology meant. I learned that advance health care directive is the general term for a legal document that spells out your decisions about end-of-life care ahead of time. Advance health care directives generally include two important components: a power of attorney for health care and a living will. A power of attorney for health care names your health care agent (also sometimes referred to as a health care proxy), the person you designate to make health decisions for you if you are unable to do so - in my case, this is of course Seth. A living will describes which treatments you want if you are dying or permanently unconscious, and when you want to accept or refuse medical care. I chose to also include an extra section about my non-medical wishes for the time of my death and afterwards.

Although black humor has sustained Seth and me through much of my treatment, when it came to my advance directive, as my father-in-law put it, there was just no way to get a laugh. Thinking about dying - or more specifically, thinking about the impact that my death would have on those around me, especially Seth and Ike - reduced me to tears more than once when I was preparing this document. However, I never considered not doing it, as difficult as it was. I think it's part of getting older and also part of becoming a parent - the discomfort of considering unpleasant possibilities becomes less important than trying to minimize the burden on your loved ones at what would be one of the hardest times of their lives.

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MY MEDICAL TREATMENT

If the time comes that I am very sick and am not able to speak for myself, I want the following wishes, and any other directions I have given to my Health Care Agent, to be respected and followed.

• I do not want to be in pain. I want my doctor to give me enough medicine to relive my pain, even if that means that I will be drowsy or sleep more than I would otherwise.
• I do not want anything done or omitted by my doctors or nurses with the intention of taking my life.
• I want to be offered food and fluids by mouth and to be kept clean and warm.

I consider life-support treatment to mean any medical procedure, device, or medication necessary to keep me alive, including the following: medical devices put in me to help me breathe; food and water supplied by medical device (tube feeding); cardiopulmonary resuscitation (CPR); major surgery; blood transfusions; dialysis; antibiotics; and anything else meant to keep me alive. In the following situations I want to have life-support treatment only long enough to allow my husband, Seth King Jacobson, to be with me at my death:

• If my doctor and another health care professional both decide that I am likely to die within a short period of time, and life-support treatment would only delay the moment of my death.
• If my doctor and another health care professional both decide that I am in a coma from which I am not expected to wake up or recover, and I have brain damage, and life-support treatment would only delay the moment of my death.
• If my doctor and another health care professional both decide that I have permanent and severe brain damage (for example, I can open my eyes, but I cannot speak or understand), and I am not expected to get better.

MY END-OF-LIFE CARE

• I wish to be treated with dignity at all times.
• If I show signs of depression, nausea, shortness of breath, or hallucinations, I want my care givers to do whatever they can to help me.
• I wish to be kept fresh and clean at all times.
• I wish to have personal care like nail clipping, hair brushing, and teeth brushing, as long as they do not cause me pain or discomfort.
• If I am not able to control my bowel or bladder functions, I wish for my clothes and bed linens to be kept clean, and for them to be changed as soon as they can be if they have been soiled.
• I want my lips and mouth kept moist to stop dryness.
• I wish to have pictures of my loved ones in my room near my bed.
• I wish to have my favorite music played when possible until my time of death.
• I wish to be taken outside as much as possible.
• I wish to die in my home if possible.
• I wish to have people with me when possible. I want someone to be with me when it seems that death may come at any time.
• I wish to have my hand held and to be talked to when possible, even if I don’t seem to respond to the voice or touch of others.
• I wish to be cared for with kindness and cheerfulness, not sadness.

WHAT I WANT MY LOVED ONES TO KNOW

• I wish to have my family and friends know that I love them.
• I wish to be forgiven for the times I have hurt my family, friends, and others, and I wish to have my family, friends, and others know that I forgive them for when they have hurt me in my life.
• I wish for my family and friends to know that I do not fear death.
• I wish for all of my family members to make peace with each other before my death, if they can.
• I wish for my family and friends to remember me as I was before I became seriously ill, but also to know that I feel that my illness changed me for the better.
• I wish for my family and friends and caregivers to respect my wishes even if they don’t agree with them.
• I wish for my family and friends to look at my dying as a time of personal growth for everyone affected by it. This will help me live a meaningful life in my final days.
• I wish for my family and friends to seek help if they have trouble with my death. I want memories of my life to give them joy and not sorrow.
• After my death, I wish for all my usable organs and tissues to be donated for transplant and/or medical research. I wish for any remains to be cremated and my ashes scattered at Tomales Bay, California. I authorize my husband, Seth King Jacobson, to make all arrangements, including alternate arrangements as he deems necessary.
• After my death, I wish for my family and friends to honor my memory through their relationship with my son, Isaac Noah Jacobson. Please share with him your memories of me, and please give him the love that you once gave to me.