Deciding for ourselves

These are terrifying times, especially for older people. Keep in mind that the great majority of us won’t get COVID19, or will recover if we do. As New York City parks turn into temporary hospital and burial grounds—yikes!!!—it’s hard not catastrophize, but anxiety is itself a health risk. Even most of the 80- and 90-year-olds who catch COVID19 will pull through. Remember, too, that  should the worst happen, you have the right to decide your own fate.  At a time when huge aspects of our lives feel out of our control, that’s an empowering idea.

You might want doctors to do everything possible to keep you alive. You might feel like many of my GP’s older patients, who’ve told her they never want to be put on a ventilator. Maybe you don’t even want to be taken to the hospital, like New York’s Shatzi Weisberger or many of the Britons who called into this BBC-4 radio show. Or perhaps, like me, you fall somewhere in between, with those who’d like to be intubated but not kept alive if our organs start to fail and our brains are affected. I doubt it’s going to come to that because I’m lucky enough to be able to stay inside during these grim weeks, and I sure hope you can too. In any case, I want people to know my wishes so they can help carry them out.

No matter what you think you’ll want, the most important step is to tell someone, or a group of people.  As gerontologist Jan Baars puts it,  “Autonomy requires collaborators.” This benefits you, first and foremost, as well as those who care about you. Choose an official, trusted Health Care Proxy, the person who will insist that healthcare providers meet your conditions if you can’t speak for yourself. The Conversation Project offers great suggestions for getting that discussion started. (Here’s how it went down with my family.) Lots of organizations, including Compassion and Choices and Prepare for Your Care, can help you assess your priorities, increase your options, and get your papers in order for free. Here’s a link from AARP to free, printable, state-specific forms. Secondly, write down what you decide. Fill out an Advance Directive and sign it.  Then make copies for your Health Care Proxy and your primary care doctor, and keep one by your front door in case of an emergency.  Make your wishes known!

It’s way better to do this stuff around the kitchen table than during a crisis. Hopefully these documents won’t come in handy for many more years. But in the weeks immediately ahead, especially for those of us in the pandemic’s global epicenter, there are unlikely to be enough medical resources to go around, which has engendered much debate about the value of older people’s lives. (See links below to some good articles about the complex ethical calculus involved in medical rationing.) At any age and in any condition, everyone has the right to want to stay alive. Now’s the time to make your wishes known and enforceable.

Addendum: This article in Mother Jones by Clara Jeffery, “The Passwords He Carried,” has many more suggestions for getting our papers in order.

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Washington Post: “Here are rules doctors can follow when they decide who gets care and who dies,” by Daniel Wikler April 1, 2020 

Ars Technica, “In ERs overwhelmed by COVID-19, here’s who might get treated—and who might not,” by Beth Hole,  March 26, 2020

Wall Street Journal, “Rationing Care Is a Surrender to Death,” by. Allen C. Guelzo, March 26, 2020   

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