Retaining Control Over Decisions

People can retain control over the decisions that they confront near the end of life, even as they become less able to care for and speak for themselves.

Advance Directives

A living will allows a person to explicitly state his wishes regarding health care in the event that he can no longer speak for himself. A durable power of attorney for health care (called a health care agent or health care proxy in some states) authorizes a specific person, often a spouse or adult child, to make health care decisions for a person who can no longer speak for himself.

In many cases, when a living will or a durable power of attorney for health care does not exist, several family members participate in making decisions. However, problems may arise when family members disagree over the best course of action for a sick relative. The family's wishes may contradict those communicated by the dying person, or the dying person's wishes may be unknown to the family. To avoid such problems, family members should try to follow the dying person's preferences and interests regarding treatment rather than their own. In addition, family members should do their utmost to resolve their differences before becoming involved in treatment decisions. It is also often helpful to have a family meeting to communicate those decisions, ask questions, and receive information from health care practitioners. However, a single family spokesperson should be appointed to improve the efficiency and clarity of communication between meetings.

Assisted Suicide

In assisted suicide, a dying person asks a doctor to help him end his life, usually by prescribing a lethal dose of drugs to be taken at the time of his choosing. Assisted suicide is currently legal in only one state in the United States (Oregon). Euthanasia, in which a doctor personally administers a treatment with the intended purpose of bringing about death, is illegal in the United States but is legal in the Netherlands. A small number of dying people ask their doctor to assist them in ending their life, even in places where it is illegal.

Depression and hopelessness are among the main reasons for these requests. Other reasons include a sense of being a burden to others; loss of independence; loss of control of bodily functions; inability to participate in enjoyable activities; a wish to control the circumstances of death; and physical suffering. A request for assistance in dying should be considered a sign of extreme distress and should never be ignored. Exploring the reasons for the request, asking about fears and worries, and listening to the person making the request are important.