Ask people what they want at end-of-life and most will saythey want to live long healthy lives and die in their sleep. Very few want tostretch out their final days in the hospital Intensive Care Unit (ICU) tetheredto machines. Unless we plan ahead and speak up, we may not get what we wantwhen it comes to end-of-life issues.

Finish Strong: Putting Your Priorities First at Life’s End by Barbara Coombs Lee is a great guide book to help people navigate the rocky shoals of end-of-life. It provides specifics about how to talk about one’s priorities with doctors, family and friends. It offers information about options such as hospice, the concept of slow medicine, and steps to take to escape dementia and the diminishing returns of over-treatment. It helps clarify decision-making during a healthcare crisis.

With a background as a nurse, physician’s assistant, attorney,and health care policy advocate, Coombs Lee became the CEO and now thepresident of Compassion &Choices. Compassion & Choices is a national organization that educates aboutend-of-life options and advocates for the rights of terminally ill people tomake decisions about how and when they die. She was one of the key peoplebehind the establishment of the Death with Dignity law in the state of Oregon,the first state in the U.S. to allow medical aid-in-dying.

Establishing Your Priorities

The book is filled with helpful bullet point boxeshighlighting steps to take. In “Talking About Your Priorities Early and Often,”Coombs Lee guides readers to state their desires balancing quality and quantityof life, documenting those wishes, stating them in terms of health caredirectives, and making sure the right people have those documents.

Patients are directed onto the conveyor belt of increasinglyinvasive and intensive medical care at end-of-life. Knowing a person’spreferences, and having those preferences documented, provides a guiding lightin a dark time of medical crisis.

A Real Life Example

I’ve seen this within my own circle of friends. An 86-year-oldman fell and hit the back of his head, resulting in a life-threatening hematomaa large blood clot) pressing on his brain. Over the preceding years, hisquality of life declined significantly, with mobility and pain issuespresenting growing challenges. He had an advance medical directive and Do NotResuscitate (DNR) order in place.

Over two weeks, he was hospitalized in intensive care, sentto a rehab facility, then back to the hospital. He was somewhat responsive, buthis awareness declined as time went on. During the second hospitalization, asurgeon said they could drill a hole in his skull in an attempt to relieve thepressure from the hematoma. However, he could not say if the surgery wouldimprove his health and said it may result in death.

Recognizing that his time was limited, his family opted forhospice care. He was transferred to an in-patient hospice, where he was caredfor in a beautiful facility. He was kept pain-free, clean, and comfortable.While he was mostly unresponsive during those last five days, his family andfriends visited daily and said their goodbyes. It was a peaceful transition,and isn’t that the best that one would hope for?

Guidance in Multiple Arenas

FinishStrong: Putting Your Priorities First at Life’s End offers specificdetails to help people retain control over how they face their final days. Theinformation includes how to:

• find a doctor who will work with you on yourwishes;
• evaluate whether a test or procedure would helpor hurt;
• pursue the most conservative course of actionslow medicine);
• choose and work with a good hospice program;
• decide if living with severe dementia is worsethan death and how to legally and ethically escape this condition.

The book also includes a comprehensive overview of thehistory of the death with dignity movement in the United States. As ofmid-2019, these jurisdictions have adopted some form of medical aid-in-dyinglegislation: California, Colorado, the District of Columbia, Hawaii, Montana,New Jersey (starting August 1, 2019), Oregon, Vermont and Washington. And on June12, 2019, the governor of Maine signed legislation to make it legal in thatstate. Coombs Lee also includes information on how to advocate to advancemedical aid-in-dying.

Despite great advances in medical care, humans do still havea 100% mortality rate. While opponents label medical aid-in-dying as assistedsuicide, we are all going to die. This option is extended to individuals whohave a terminal illness with a prognosis of six months or less to live.

Having your say in how you meet your earthly end is key to agood death. FinishStrong provides the information and tools to help us finish our lives ina way that reflects our core beliefs and values.

Gail Rubin, Certified Thanatologist, is apioneering death educator who works with companies to connect with baby boomersconcerned about end-of-life issues. She speaks at and coordinates multiple BeforeI Die Festivals. She also is the author of three books on end-of-life issues. AlbuquerqueBusiness First named her one of their 2019 Womenof Influence. Learn more at www.AGoodGoodbye.com or www.BeforeIDieNM.com.