Holiday greetings friends. I am your local, friendly, community, neighborhood, emergency doctor here. I also happen to be on our local hospital ethics committee. I want to take this opportunity around the holiday time to talk to you about death.
Death is a tough subject to talk about. Some of us meet with estate lawyers and plan for it. Some of us are in denial of its impending arrival. Some of us meet regularly with a religious or spiritual leader in anticipation of its arrival.
Tibetan Buddhist philosophy teaches us that acceptance of this fundamental human condition is the key to understanding a deeper truth and sense of compassionate purpose. Holiday times are the perfect time to talk to family and loved ones about death. If you are ever struck down by a bus, infected with a plague, afflicted with a terminal illness, the friends and family who will be helping you with your end-of-life decisions, are probably sitting around your holiday table. Here are some suggestions on how to have a meaningful conversation about death around the holiday table:
• Talk to your family about your goals and values. Would you want to be kept alive on a life support ventilator and artificial nutrition through a tube, or would you want to be at home surrounded by family? Would you want to be kept alive if you were unable to eat, or unable to talk, or unable to do the things in life that give you joy and purpose? What are the things in your life that give you joy and a sense of purpose, and would you want to be kept alive if you cannot have those things? Is there a milestone you want to stay alive for — a graduation, wedding, anniversary? Whatever your values are, be sure your family knows an understands them. The people sitting around your Christmas, Hannukah, Winter Holiday meal are the ones who are going to be asked these same questions when you are struck by disaster. Don’t assume they know what your priorities are, tell them.
• Appoint a health-care power of attorney or health-care agent. If you are ever debilitated with injury or illness, pick someone who knows you well who can make decisions on your behalf. If you have a strained relationship with your adult children, parents, spouse, or siblings, then appoint a friend or confidant who can speak on your behalf. Someone who knows you well, and who you trust. Make sure that this person will act in your best interest, without conflicts of interest, and is willing to make hard decisions to advocate for your values. Contact a lawyer or use an online legal service to complete the paperwork, and be sure that the information is available if you are ever hospitalized or in an accident.
• Fill out a POLST (Physician Order for Life Sustaining Treatment). Your primary care physician or advanced practice provider can help you fill it out and sign it. You can download forms at https://capolst.org/polst-for-healthcare-providers/forms/. This is a one-page, double-sided, bright pink form that tells health-care workers and 9-1-1 first responders what your wishes are. If you have a POLST, it is usually scanned into your electronic medical record. Many advance directive documents can be lengthy and detailed; this focused and succinct form tells us if you want CPR (cardiopulmonary resuscitation), what type of medical interventions you want and do not want, if you want artificial nutrition, and who your health-care power of attorney is. Every adult should have a POLST form. Be sure your POLST form is visible or easily located, and be sure your neighbors, friends, and family know to notify 9-1-1 of its existence should there be an emergency.
• Revisit the conversation regularly. Talk to you family and health-care power-of-attorney person after major diagnoses and major events, if your health deteriorates, if you have a new unexpected diagnosis, if there is a change in living environment, if you are recently hospitalized, or if you change your wishes. You are in the driver’s seat. Maybe even make it a yearly holiday tradition to go around the table and be sure everyone knows what end-of-life wishes are. Our values evolve with circumstance and life’s perpetual challenges, so be sure that everyone is on the same page.
All of us in emergency services wish you a happy, healthy, and safe holiday. Be sure to get plenty of sleep, stay hydrated, get your flu shot, eat healthy, exercise regularly, treat your neighbors with kindness, and try to avoid visiting us in the emergency department. But if disaster does come unexpectedly, please be prepared. And know that we are always a 9-1-1 call away and you have a team of extraordinary professionals ready to help.
Start having the tough conversations so we can better serve you with the best possible medical care that is consistent with your values. Please review resources below. And for all of you who are in health-care, law enforcement, EMS, dispatch, fire services, and mental health, it is an honor and privilege to serve our Santa Barbara community alongside you. Thank you for working this and every holiday season. Happy Holidays. Stay healthy and kind, Santa Barbara.
National Institute on Aging, Advance Care Planning: Health Care Directives:
Cottage Health, Advance Directive Program:
Sansum Clinic, Advance Directive:
Cencal Health, Advance Directive:
Veterans Affairs, Advance Directive:
Get it Done, Advanced Healthcare Directive for South Santa Barbara County:
Jason Prystowsky MD, MPH is a community emergency physician in Southern California. He has a master’s degree in public health and has a background in global health, community health, emergency medical systems, disaster humanitarian response, and medical ethics. Any opinions shared in this article are his own and do not reflect any institutions of which he is affiliated.