Consider end-of-life options carefully

Our heart goes out to Karen Okada, who lies dying while her family and the lawyers argue over her body.

This 95-year-old woman expressed in her 1998 written "living will" (advance directive) not to have her dying "artificially prolonged."

We have all heard how important it is to create an advance directive if we hope to make the journey to death in a manner consistent with our values. Mrs. Okada’s experience makes clear this is not as easy as filling out a form and filing it away.

Last month, Mrs. Okada suffered the latest in a series of medical crises that began in December. Her doctors at The Queen’s Medical Center determined she was beyond recovery and recommended removing her feeding tube.

A complicating factor is present, though. At the same time she documented her wishes, Mrs. Okada also completed another equally important advance-planning document: She appointed her brother as her health care proxy to make medical decisions if unable to do so herself. He insists the feeding tube stay in place.

We cannot know what is in her mind now. Is this the kind of condition she wanted to continue in? How can you be sure your wishes will be followed?

Compassion & Choices (www.CompassionAndChoices.org) educates, supports and advocates on a broad range of end-of-life issues. Our counselors help thousands of people each year find peaceful deaths that honor the values of a lifetime. They advise that you must not only document your wishes, but also discuss them with your health care proxy and satisfy yourself that he or she is the right person to honor them when the time comes. Make sure your proxy understands your desires, and is able and willing to see your wishes carried out. Sometimes it can be hard to convince a loved one that, under certain conditions, allowing you to die will be the best way to care for you and express love.

Before asking someone to be your proxy, ask yourself, "Are they assertive? Are their values aligned with mine? Will they respect my choice even if grief or pressure from others makes it hard to do so?"

Review and discuss these documents regularly. Your family should know what your wishes are and why. Your doctor also should know where you stand, and you should feel comfortable that he or she will advocate respecting your wishes. It appears that The Queen’s Medical Center physicians acted to respect Mrs. Okada’s directive. Unfortunately, her proxy demands treatment in conflict with her expressed wishes, forcing the dispute into court.

Compassion & Choices supports an individual’s decision on how to approach dying. We believe patients within six months of death are entitled to make their own end-of-life choices. For mentally capable patients, this includes the choice to request medication to assure the possibility of a peaceful death.

We offer guidance to individuals facing a terminal illness or just planning ahead, and we work for public policies that support individual choice and a full range of options at the end of life.