Never Put Me in a Nursing Home

Written by on November 12, 2015 in Blog with 0 Comments

Dear Friends,

I’ve not blogged for many months, and I apologize.  There were many reasons which I will spare you.  But

I’ve made a commitment to start blogging again.  Not twice every week, or even once; no preset goals.  When I find something worth a comment, I will post it.

I will be counting on Many of you to give me interesting material.  Several of you have even during this hiatus, and I appreciate it.

I have enlisted some professional help, and am in the process of up-dating Final Exodus:  some additional text, some wordsmithing, new resources, etc.  I’m having my advance directive form reviewed by doctors and hospice nurses.  Most importantly I am assuring myself that everything is working properly: the links, your ability to get blogs automatically, your ability to contacting, and more.  If you find any errors please let me know.

Hopefully this process will be finished before the December holidays.

Meanwhile, I will do a bit of writing. Here is the first piece.

* * * *


Making such a demand is a terrible mistake.   In fact all absolutes are a mistake when it comes to making advance decisions near the end of life.   There is truth in the cliché, “never say never.”

Dr. Abigail Zuger, M.D. tells about an elderly patient who was finally brought to the hospital with a deep, malodorous and infected pressure sore on her back – a bed sore not treated (N Y Times Blog, Nov. 9 2015).  Why? The woman had instructed her children “Never put me in a home.”   They honored the request.  Eventually the bed sore got out of hand, and they finally realized they had to call 911.

Zuger points out that such absolutes don’t belong in an advance directive.  She says, “[Advance directives] are supposed to give people some control over the future.  More often than not … the future refuses to be controlled.”  I couldn’t agree more.  We die in thousands of different ways, so saying “absolutely no” to a particular treatment or situation makes no sense. There MAY BE a situation in which an abhorred treatment is the best.

She further cautions about directives.   They may not be detailed enough, or they may be too long.  Furthermore, they may be over looked by medical people, even ignored.  Or they may be lost.   In other words, there is no perfect advance directive. They can’t possibly cover all the situations you might find yourself in.

What Zuger fails to clearly state is that there is a rather good solution to the always-imperfect advance directive.  That is: in depth conversations with your agent/proxy about your attitude towards ending life.  Is quality of life key or is living at any cost key? Do you want in given circumstances to hasten death, or to just let nature take its course?  And so on.    After you have clarified your view about your end of life, it not only must be shared with your agent/proxy, but with everyone who might be at your bed side when you are unable to speak for yourself.  Your directive should give you agent some wiggle room, some discretion.

As a lawyer I’ve been trained to get everything in writing. But lately I’ve learned — from many doctors and nurses — that these conversations are far more important than ANY writing.

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