When I was diagnosed with cancer, even though I had a decent chance of surviving it, I knew that it was time to have a conversation with my husband about how I want to die, and the conversation couldn’t be “If there’s no hope, let me go.” My husband is an unrelenting optimist with enormous faith in the power of human ingenuity. If I give him wiggle room, he will hold out for a miracle, and I don’t want to die by inches.

As a physician working in the intensive care unit, I have learned that traditional advance directives are almost entirely useless. At best they are too vague to serve as roadmaps for caregivers, and at worst they interfere with the provision of good care. Doctors and nurses don’t need to be told what treatments they can and cannot provide; they need to understand their patients’ priorities and goals. A statement such as, “You can do CPR but you can’t put me on a breathing machine” provides no guidance for myriad other important medical decisions and can lead to unintended consequences, such as withholding pain medication for fear of compromising respiration. “I want to live until my grandson’s wedding if at all possible, but my first priority is to be comfortable for whatever time I have left” would be a more helpful statement.

image: Aditya Suseno CC BY-SA 3.0 https://upload.wikimedia.org/wikipedia/commons/thumb/9/95/CPR_on_Hospital.jpg/450px-CPR_on_Hospital.jpg 

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