One of the hardest aspects of being alive in this miraculous world of ours is that each one of us, and every single other human being that we know, only have a limited time here with each other. Most of us do not want to think about death, much less bring it up with our family or loved ones; we believe that death is too disturbing or traumatic to be addressed in polite conversation. Most people thus leave this, one of the most difficult and important discussions, until absolutely necessary.
The coronavirus pandemic is changing a lot about the way all aspects of life are considered, and preparing for death is no exception. While most of the conversations around vulnerability to COVID-19 have revolved around people with preexisting medical conditions and/or those over the age of 60, the truth is that many young, healthy, athletic adults are also succumbing to the infection. While the former group is more likely to have some form of end-of-life wishes document in place; the latter is very unlikely.
Hospital doctors and nursing home staff are increasingly finding themselves in heartbreaking situations where they have to personally facilitate goodbye phone calls and communications when someone without care is rushed to the hospital. Under new restrictions, most people hospitalized now will recover or die without the comfort of in-person visitors, among other current realities. The sad truth is that it’s very likely that for the next 2 years, one of the most caring and loving things every mentally sound adult over the age of 18 can do for friends and loved ones is to be prepared for end-of-life arrangements. This means having an advance directive written and on-file, having assigned designated proxies or advocates that they do not live with, and having conversations with people they would like to have involved in end-of-life care should it become necessary.
For people who have taken the steps already to identify their wishes, one of the surprising findings they share with is that conversations about death are based on beliefs and values regarding quality of life, autonomy, faith, love, legacy, and all the other qualities that we generally associate with living a full and healthy life. There are many great resources online.
This article seeks both to provide guidance to some steps you may want to consider around making advance care decisions and discussing your wishes and also for working through the powerful emotions that these conversations and actions can invoke. I will provide at least one good resource for each step mentioned below; understand that there are many others available through medical schools, legal sites, religious organizations, and others.
Here are some of the most important questions you might want to consider if you are in any stage of the process of defining the care you and your loved ones and possessions will receive should you face the need for emergency medical care (COVID or non-COVID-related) in the time of the SARS-CoV-2 pandemic.
1. If I were incapacitated, who in my life could I trust to make rational, compassionate decisions on my behalf? Depending on which state/ country you live in, this person could be a spouse, intimate partner, extended or immediate family member, close friend, etc, and may go by a different name. It should not be your medical doctor; this person will need to be involved in the conversation with your doctor. You should have more than one, as well, in case one cannot meet the requirements.
2. Do I understand the technical aspects of life supportive care, such as intubation, aggressive antibiotic treatment, palliative care, etc.? Do I know what my personal beliefs are surrounding its application and duration of use? Have I defined those wishes?
3. Do I know what the legal requirements are for creating an advance directive on the state or country I live in? Do I have a document created, and does someone know how to find it?
4. If I have a document in place, have I considered how it would get to my doctor or attending physician were it needed? Would there be benefit in registering my directive and carrying a card with my registration number on it?
5. Have I considered and formally registered wishes regarding donation of my organs and/ or body?
6. Have I pre-selected funeral or cemetery services? Do I know how I want my remains and services to be handled in the age of coronavirus? Is there someone I trust to organize social-distancing appropriate services if necessary?
7. Have I considered a communication chain for information regarding my medical condition, should I be unable to communicate personally? Are there sensitive issues surrounding toxic, abusive, or narcissistic family that need to be addressed?
8. Do I have a plan in place for communicating these wishes to important and trusted members of my family and/or close loved ones?
9. If I do die unexpectedly, do I have a list prepared for my loved ones to contact my bank, find my important documents, manage important social media accounts, contact my employers or clients, etc.?
10. Have I considered my wishes for any professional publications, websites, or other professional or creative legacy records?
11. Have I created a list of my most treasured possessions and pets, and do I have someone in mind to receive and care for or use them after I am gone?
12. Do my close loved ones have access to support networks and resources to help them deal with grief? Would I consider reading a book or watching a video series with a trusted group and discussing our questions concerns, thoughts, and feelings like one would do for a book club reading?
13. Most people die with regrets over important things they did not say or write while they or loved ones were alive. Do I have something I need to say to someone? If I cannot say it, can I write it? How can I make my letter easily found?
14. Have I considered who I want to handle my spiritual needs through my illness and recovery or death?
We consider these and other questions as a loving gesture to our family and loved ones, in hopes they will not be needed. I hope this article brings peace and clarity, and serves as the basis for important discussions.
Rachael Shenyo is a US national living and working in Central America as a development specialist, scientist, writer, and life coach. In her coaching, she specializes in helping people find and hear their inner voice, and act upon their life goals. In her scientific work, she works with climate change. Her professional profile may be found on LinkedIn.