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Dr. George Bartley

The best-laid plans

Dear Readers,

In previous columns, I've shared perspectives on Mayo Clinic's history and culture, expressed my opinions about the way health care is delivered in this country, and offered suggestions about leading a healthier life. The theme of this essay is different: planning for death.

Let's start with the legal compulsories. Every adult should have an up-to-date will, but too many people do not. If yours is inadequate (or nonexistent), please take care of that — this week, if possible. A functional will requires at least a baseline level of financial planning, which I suspect is the rule amongst people who take the time to read this column. If you've neglected such preparations, however, please attend to them soon.

Next, exercise your right of autonomy by ensuring that you have advance directives, which are statements that clarify your intentions about medical decisions. Three types of advance directives are recognized in Florida.

The first, popularly known as a living will, specifies what kinds of medical care you wish to receive or refuse if you become incapacitated and are unable to make such decisions. Remember that doctors and nurses, in the absence of such instructions, are obligated to do all that they can to keep you alive, even when such interventions may serve more to delay death than to prolong life. Every serious medical circumstance is unique, just as every person is unique, and it is helpful to both family members and health-care providers to have a clear understanding of your wishes.

A second type of advance directive designates a person (a surrogate) who can make health-care decisions on your behalf if you are unable to do so. Again, proactively determining who should best speak for you can help take a lot of pressure off your loved ones.

Finally, an advance directive can indicate your desire to donate, at death, all or part of your body for organ or tissue transplantation or for medical education or research. Additional information about advanced directives and organ donation can be found at www.mayoclinic.org/becomingpat-jax/directives.html and www.organdonor. gov respectively.

Other less formal preparations can be of immeasurable help — a gift, even — to your family members and friends. Compiling list of persons who should be notified of your death, specifying the disposition of your remains, indicating what music or readings you would like included in your memorial service, drafting an obituary: such planning, although potentially uncomfortable to discuss with your loved ones, helps to honor the deceased and to comfort and console those who survive.

Our family experienced a sudden, unexpected death recently, but one of the redeeming consequences was the discovery of notes and journal entries from the deceased that helped promote reconciliation and healing. Long illnesses have obvious drawbacks, but they may afford opportunities for closing conversations with family and friends. Yet even in the closest relationships, important things may be left unsaid and unresolved. Putting your thoughts in writing or creating an audiotape or video are excellent ways to "close the loop" with those who are most important to you.

None of us will escape death, but with thoughtful planning we have the ability to diminish its sting.

Sincerely,

George B. Bartley, M.D.
Chief Executive Officer