End of life, personal communication

I wrote the following to express my values to my attorney-in-fact so that they may be reviewed should the time come. This is in addition to other routine papers that one should execute. Many have wanted to use it to formulate their own statement. Although it is personal, it is not confidential.

San Diego, California
June 30, 1998

This is an expression of my desires, in addition to other communications, relevant to my Durable Power of Attorney for Health Care, to guide the attorney-in-fact in making decisions regarding my health care in the event that I should be incompetent. All of the decisions that I request be made are, to me, acts of kindness, respect and love.

I believe that medical care should strive to add life to one’s years more than years to one’s life; that is, the quality with which one lives has an overriding value rather than the length of a life markedly deficient in those things that bring a sense of joyful expectation of the morrow. I have had a life that has enjoyed the cerebral realm more than the physical. To continue to live devoid of major cognitive abilities would be most unacceptable. I have tried to be of value to others and don’t want that to be erased by years of being burdensomely dependent on others - a burden as I, not they, would see it. I don’t want to live after dementia has robbed me of the joy of recognizing my friends and loved ones or the thrill of learning a new concept.

Death is not the enemy. Death is the natural, ordained end to this life. Its associated grief should be transient and supplanted by the joy and vigor provided by the birth and growth of children. What one receives from one’s parents is not owed equally back to them, but is properly given to the youngest generation, providing an onward flow of wealth in the fullest sense of love, wisdom and assets. Inordinate expenditures to fight an inevitably-losing battle against the death of the old should not be made at the sacrifice of the welfare of the young.

I have an abiding comfort in the grace of God and accept the assurances of the Christian faith. I have engaged the idea of atheism and have found it wanting for me. I have been unable to envision the existence of life and the universe without an ultimate consequence that can only be provided by the concept of God.

I am specifically concerned about the possibility of developing dementia (like my dad and friend have had) that is not yet successfully treatable, although there are innumerable other situations to which the concepts expressed here would also apply. There is a familial tendency and some specific genes are associated with Alzheimer’s disease, but the causal relationship is not absolute. Were I to start having symptoms of AD, I would have the option of committing suicide. To do that would require a sufficient level of competence and therefor would have to be timed early in the course of the disease. That might waste some time of worthwhile life to ensure against slipping into a state incapable of committing suicide.

Alternatively, I would like to be assured, that should I develop dementia, I would not have any life-threatening process interrupted by medical treatment. In case of my dementia, I request that the attorney-in-fact refuse any medical treatment of a life-threatening illness no matter how simple or effective such treatment might be. The attorney-in-fact need not understand the nature of the disease or the usual medical treatment available to treat it.

Intravenous morphine, or comparable drug, should be given in sufficient quantities to relieve all pain and discomfort (narcosis) even though that might necessarily be acutely fatal via effects on blood pressure, breathing etc. Pneumonia is a common event in more advanced dementia. Antibiotics and oxygen should not be given. Instead, morphine should be given to relieve the distress of respiratory failure, recognizing that it would aggravate the basic failure in respiration while relieving the distress of the failure. Narcosis, in whatever situation, would be associated with inability to drink fluids normally. No fluids should be given by alternate routes to maintain hydration, just that quantity necessary for administration of morphine or drugs similarly intended for relief of pain. The basic illness and the dehydration should provide a death without prolonged delay, a matter of a few days at most.

This document is for use by the attorney-in-fact in fulfilling my desires. Although, it may be shown to the doctors involved in my care to demonstrate that the attorney-in-fact has been told of my desires, it is the function of solely the attorney-in-fact to interpret it. No one else is to use it to argue the appropriateness of the decisions that the attorney-in-fact makes. I have executed the Durable Power of Attorney for Health Care and chosen the attorney-in-fact and alternates knowing that they will be benefactors from my death. No one is to impugn the ensuing decisions on that basis. Should any doctor be unwilling to provide pain-relieving care when prevented from providing life-saving treatment, the services of a compliant doctor should be obtained.

Someone might argue that as long as life exists there is a chance of a new drug being discovered for dementia that would restore desirable life. I understand that argument at this time and deem the reasons behind this document make the risk of foregoing such a satisfactorily restored life a reasonable risk to take. After all, young, healthy people risk losing the desirable, full life that they have in exchange for dangerous recreational activities. What I am asking is that an undesirable life be allowed to end at the risk of foregoing a chance of a satisfactory life for a relatively short additional time of life expectancy.

Again, there are many other disorders analogous to dementia to which the principles expressed here would apply.

David F. Thomas