Important conversations

By Dr. Batya L. Ludman, Psy.D., FT · Published September 4, 2020

After months of dealing with the many painful aspects of COVID-19, which first hit us in March, and which seems to have already lasted a lifetime, it would be wonderful to put it all behind us and move on.

While trying to decide on a column topic, not related to coronavirus, it seemed dismissive to move on, especially given all that we are still going through and with all the uncertainty of whether there is even worse to come. It therefore felt remiss of me not to address this particularly important topic. While a difficult one, there really is no better time to talk about it than now. It is time for parents to sit down with their grown children and couples to sit with each other, and engage in an open, honest and safe conversation about what their end of life desires would be, when G-d forbid, that time comes.

Having recently written an article for bereavement therapists on "COVID-19 and its impact on the Jewish community", I am reminded of the many stories where a patient deteriorated so rapidly that life and death decisions had to be made without being able to consult with the patient, family members or a Rabbi. Most of us would have valued the opportunity to talk over what we would like the final stages of our life to look like. Fortunately, you can now be proactive about this for both yourself and your loved ones.

While in theory, one might welcome the opportunity to clarify what they would want at this point in time, while healthy, many may choose not to discuss difficult end of life decisions and put them off because facing the inevitable is truly painful. The topic feels very morbid and many avoid discussing it, because they don't wish to burden those they care most about, and fear upsetting their loved ones, reminding them of their vulnerability, that they will not live forever.

While Judaism always encourages the maintenance of hope until the very end, it does however take a realistic stance on preparing for our final days.

If nothing else, these past months have taught us all that stress and anxiety may increase when feeling out of control and uncertain with respect to what may be just around the corner, let alone in the distant future. Given that we generally feel calmer and more settled when afforded the opportunity to plan as much as possible for our end of life concerns, now is a good time to attend to this.

Even if there might be travel restrictions or the inability to currently meet face to face with your loved ones, it behooves you to ensure that they have heard your desires and that you have heard theirs as soon as possible, thereby contributing to everyone's physical and emotional well-being so that both you and they feel more settled. The concept of a good death is in no way an oxymoron, and having been present at several, I can attest that when someone's wishes have been heard, it allows for much greater peace in the waning hours of life.

Here are some suggestions for helping to make this happen.

  1. While perhaps not easy to initiate, a discussion about your wishes and concerns is very important for both you and your loved ones. Making time to formally or informally have this conversation, ideally while you are still healthy but really anytime, allows you to share your objectives and expectations for how you'd like things to progress.

    Acknowledging that it is okay and safe to have the discussion also affords everyone the opportunity to gain reassurance and lower their fear about concerns such as pain or possibly dying alone, or any other major worries that may have gone unspoken.

  2. Given that with COVID-19, some patients became very sick, very quickly, and with lockdowns among other issues preventing family from being with their loved ones, people did not necessarily have the time to put their affairs in order, get closure or say their good-byes.

    If something were to happen tomorrow, it is important for you to ask yourself today if you have any unfinished business and just what it is. Have you expressed your love and gratitude to those you love? Have you made amends or forgiven those you would want to talk with, so that there will be no guilt or regret down the road? Have you said what you want to say to those people who are important to you? Have you drawn up a will and is it current? Have you thought about who you would want to have your treasures?

  3. As you begin to consider what advance directives you might like in place, ask yourself what is important to you and what you would like should you become seriously ill. What would you like your final days to look like? Would you want to be at home, go to the hospital, or be cared for in hospice? How do you feel about organ donation and do you have an organ donor card? What would you like your funeral to be like?

  4. Talk with your physician to get a better understanding of what issues you personally may face down the road. Would you want to pursue potentially promising treatments, and if so, how aggressively and to what degree? How heroic do you want these measures to be? How do you envision creating a balance between preserving your quality of life while also alleviating any suffering? What are your thoughts on resuscitation orders?

  5. Talk with a lawyer to explore what you need to do to formalize your wishes into a written document. Who would you want to make decisions for you should you become mentally or physically challenged? Have you legally appointed this person as your power of attorney and discussed how you feel and your wishes with them?

    This all takes more time than you might expect and will be an ongoing process for a while. These may also not be your final wishes as things may change over time. Rather this is the beginning of a process in formulating your express wishes. In what ways have you already shared your goals and dreams, your values and your hopes for the next generation and would you want to put this in a letter - an ethical will for future generations?

  6. Try to talk through and understand what may be important for a family member to know. What practical details need to be worked out? Are there other legal matters that need to be addressed? Are your finances in order and have you created a document that contains important phone numbers, account numbers, codes, and relevant information for others? Have you let relevant individuals know where these are kept?

If you have followed the above guidelines, you have planned for the worst while hoping for the best and have hopefully given yourself the peace of mind to joyfully live out the rest of your days, in much good health. Ad meah v'esrim!

A version of this article suitable for printing is available here.