A Matter of Life and Death: What we have here is a failure to communicate by Lloyd McAlister

If you want to describe the magnitude of importance for something, you may very well say it is, or isn't, a matter of life and death. Nothing is more important than the eternal matter of life and death. Unless you are a doctor or first responder in emergency situations, you are unlikely to encounter true life or death situations except in the event of a so-called “end of life” circumstance for a friend or family member. We live in an age when medical science is seemingly able to create life and then extend it beyond limits once thought immutable. We must confront in new ways the prospect that we or someone close to us will suffer a period of life with a terminal condition or a persistent, unconscious condition; a period of life which medical science now has an unprecedented ability to extend or shorten before death occurs.

What began with the case of Karen Ann Quinlan in 1976 and continued in the case of Nancy Cruzan in 1990 and again most recently in the case of Terri Schiavo in Florida, involves not only the courts but the riveted attention of the American public in the most private of inquiries into whether one of our fellow citizens exercised their so-called patient’s right of self-determination. Would Karen Ann or Nancy or Terri want to be kept alive by “life sustaining treatment”? Did they tell anyone what they wanted; did they discuss it with anyone? Is the public answering of these private questions simply a reflection of our litigious society and the willingness of a court system to go where it is neither needed nor invited? Or is there something simpler, more fundamental which is inviting, even necessitating, this human drama we see played out in our courts and the “court” of public opinion?

In these most important of decisions in life, a routine aspect of our humanity all too often fails us - our communication with those closest to us about that which is of greatest importance to us. To use the famous line from the Paul Newman movie of the 60's, Cool Hand Luke, what we have here is a failure to communicate. Let me put it to you this way, have you spoken with those closest to you about your wishes in a variety of health situations in which you might find yourself? Do you have legal documents in place which spell out your wishes concerning end of life decisions and, if so, do you recall what those documents say? Have you told your loved ones and advisors what those documents say? If you were to suffer a period of terminal illness or an unconscious condition in which you could not communicate your wishes, do your loved ones and doctors know your wishes and do they know who you’ve delegated authority to act in your behalf in such matters? If your answer to any of these questions is no, I believe it is fair to say that you and your family may someday have such private matters determined in our courts and in the court of public opinion. Remember that Karen Ann, Nancy and Terri did not have legal documents by which they exercised their rights to determine the treatment they would, or would not, receive and to appoint the agents/proxies of their choice to carry out those wishes. Today you and I would not know their names if they had exercised those rights.

If what you have is a failure to communicate, it is not too late to do something about it. Make sure your wishes are legally documented in the appropriate healthcare power of attorney and advance directive for healthcare documents. Make sure the agents/proxies you’ve delegated authority to carry out your wishes are aware of this and understand your wishes. Make sure your doctors and other healthcare providers have copies of those documents and, consequently, knowledge of your wishes. Finally, and perhaps most important, make sure all those who are close in heart, know and understand your wishes... and that you understand theirs, for when and for whom the bell tolls first we know not.