The Conversation at the Other End: The Birds and the Bees have gone quiet for winter and now we find ourselves facing the other end of the spectrum and it is time to have “The Talk”, but it may not be the one you are imaging.
“I have often thought upon death, and I find it the least of all evils.” – Francis Bacon, An Essay on Death.
In Taoism, the philosophical root of Chinese Medicine, there is an important acknowledgement that everything is impermanent and death is imminent. The philosophy involves developing an emotional acceptance of death through contemplation and meditation, as well as learning how to make use of the crises, upheavals, and changes of life. Every small change – the changing of the seasons, of the weather, the ending of a class or tv series, ultimately the changing of our bodies – is an opportunity for us to release attachment to what has ended and let go; every small change is an opportunity to accept death. “The countless changes or ‘small deaths’ we experience so frequently in our lives are a living link with real death, prompting us to let go” (Rinpoche 196).
Every small change is an opportunity for us to release attachment and let go; every small change is an opportunity to accept death.
This view of the reality that death will find us all is uniquely coupled with that of the built-in training Nature offers us with each tiny death, as preparation of our minds and hearts for the ultimate acceptance of death and dying. I find it appropriate then, as a Traditional Chinese Medicine practitioner, to bring forth some resources about how to have an open conversation around the topic of end of life planning with family and even friends.
The discussion is an important one we all need to think about and have with the people we love, both asking and answering the questions ourselves. It is not about being morbid, it is about love and being real with each other. The increased perspective can even help us to value our lives and each other much more fully.
The Conversation (to ask yourself and have with your loved ones)
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What kinds of things are important to you in your life?
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What gives you meaning and joy?
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What fears do you have about getting sick or needing medical care?
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If you were very sick, are there any medical treatments that would be too much for you?
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Do you have any spiritual, religious, philosophical or cultural beliefs that would guide you when you make medical decisions?
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If you had to choose between living longer or having a higher quality of life, which would you pick?
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How important is it to you to live as long as possible, even if it means that you would experience pain and suffering?
Consider having this conversation with your family. Use these questions as a guideline to set a good foundation and avoid unanswered questions in the event that they become relevant.
There are many resources available for setting up more structured “advanced directives”; this is just a good start.
These would be questions for patients receiving medical care for terminal illness:
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What is your understanding of your disease?
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What goals / proprieties are most important to you now?
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What trade-offs or sacrifices are you willing to make to achieve these goals?
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Resources:
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The National POLST Paradigm is an approach to end of life planning based on conversations between patients, loved ones, and health care professionals designed to ensure that seriously ill or frail patients can choose the treatments they want or do not want and that their wishes are documented and honored. Learn more about how you or your loved ones can direct their own life-saving measures. http://ow.ly/UEvWD
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The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care. http://theconversationproject.org/
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http://www.rigpa.org/en/about-sogyal-rinpoche/the-tibetan-book-of-living-and-dying.html
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Being Mortal:From Atul Gawande, a book that has the potential to change medicine and lives. http://atulgawande.com/book/being-mortal/
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The Conversation by Dr. Angelo Volandes: http://www.pallimed.org/2015/01/review-of-conversation-revolutionary.html