How Can You Tell When I Want You to Pull the Plug?

BY ARTHUR H. FABIAN, JR.

Note from the editor, Arlene Harder:

In early 2007 I received an e-mail from my brother Art whose picture above is on the homepage of this website. In it was the "Living Will" below, which he shared with his siblings and daughters. He acknowledged that he'd seen it circling the Internet for some time, but said, "I sort of liked the tone of it – flippant!  I've been wanting to elaborate on it for some time.  Finally, I got around to writing a more serious description [see sidebar]. In case you are ever involved with making decisions about my care, please note my wishes.  Louise [his wife] has read it and says it states her wishes also."

I enjoyed it so much (and the more serious one on the right) that I asked his permission to include it on Support4Change as a complement to the Five Wishes document. Hope you find something here (both below and on the right) that you can use in communicating with your own families.

Living Will

I, __________  _______________, being of sound mind and body, do not wish to be kept alive indefinitely by artificial means.  Under no circumstances should my fate be put in the hands of posturing politicians, religious nuts, or lawyers/doctors interested in simply running up the bills or protecting their butts from malpractice suits.

If a reasonable amount of time passes and I fail to ask for at least one of the following:

______a Bloody Mary

______a Margarita

______a Beer

______a Glass of Red Wine

______a Starbucks Coffee

______a Steak

______Lobster, shrimp, or scallops

______The remote control

______Chocolate

______Sex in some form

______Italian Food of any type

it should be presumed that I won't ever get better.

When such a determination is reached, I hereby instruct my appointed person and attending physicians to pull the plug, reel in the tubes and go get a beer.

_________________________________________; Date

EXPLAINING MY "LIVING WILL" INTENTIONS

BY ARTHUR H. FABIAN, JR.

One of the difficulties people have with "Living Wills" is determining just what the wishes of the "incapacitated person" really are. It's probably impossible to list all the bad states of being that could describe an older person's condition. But I'll try to describe a few situations and you can take it from there.

Note that, in no way, do I intend for this to be a legal document. It is simply to suggest some guidelines of how to interpret my wishes when I can't.

Of course, all of this assumes I cannot reasonably think and communicate. If I can reasonably think and communicate, then, obviously, none of this applies because, by definition, I can made my own decisions! However, once I don't seem to be able to make and communicate my own decisions then the only question becomes: "Will he recover or won't he?"

It's all based on what I consider a reasonable quality-of-life. That's when:

A. I can perform most of my own Activities of Daily Living (the five ADL – Wikipedia has a good simple definition) and,

B. I can converse with and enjoy the people around me. This is especially critical; when this is gone, I ought to be gone!

My age will have a lot to do with your choice of when "to pull the plug." If I'm in my sixties or early seventies, and there's a reasonably good chance I can recover and be rehabilitated, then, by all means, try to do so. But if I'm in my eighties or older, then don't bother. I don't want to go through a whole lot of therapy to only be able to drool in a wheelchair.

Well, I guess I should explain what I mean by "pulling the plug." If the conditions listed below are true, and they are not temporary, then you should:

withhold medication (except to keep me free of pain);

absolutely keep everyone repeatedly informed of my "Do Not Resuscitate" request;

remove life-support equipment;

withhold intravenous feeding including liquids (however, I'm guessing I might appreciate a little moisture to keep my mouth parts from sticking together).

I don't want to be hand fed, unless it's during a brief period of recovery. Brief? I suppose that means a few days to maybe a few months. After a month or two, review the situation.

I don't want to sit in a wheelchair and drool or stare or mumble.

If I'm severely burned, stop right there. I don't want the pain or deformity.

Don't take me out (to restaurants, public places, etc.) if I embarrass you, that is, make funny noises, have to be hand fed, say impolite things loudly, play with myself, etc. This will be a sliding scale. The criteria might be different for church, a fancy restaurant, a fast-food place, or a backyard family picnic. If I'm keeping you from enjoying the event, then my presence is not contributing anything.

When any expensive procedure has a marginal chance of success, consider my age and mental condition. The older and less mentally alert I am, the less you should consider spending on me. I'm not "worth more" just because I'm older. Quite the opposite.

Do I take a whole lot of care and am I preventing Louise or one of my children from going out and leading a "normal" life? Then the sanctity of my life doesn't trump the life of others. I DO NOT WANT TO BE A BURDEN ON OTHERS … especially for Louise and our offspring (and relatives) – all of whom deserve a life of their own. I know Louise and our daughters may feel it's their loving obligation to "give back to", or "take care of" Art/Dad. However, except for a brief period of rehabilitation, I don't want that level of care.

Dementia is not necessarily a special case. See "quality of life" above. I don't believe in euthanasia or assisted suicide, but if I can't do most of the activities of daily living, do not allow medications that prolong the "twilight" state.

My body is not "me." My ability to interact and enjoy life is who I am. God has already taken care of me in the afterlife. Do not prolong this life if I'm not engaged in it.

I think you get the idea.

Written with all my love of you and this world. February 17, 2007.

Arthur Herbert Fabian, Jr.