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Why you can't avoid expressing your end of life wishes

The question: My mother was recently in hospital and had to go into the ICU due to serious illness. While we were there, the doctors wanted to know what her wishes were – which we had not discussed before. My brothers and I got into a huge fight about what each thought was best for her. She managed to pull through and now we are having the discussion of her wishes should something happen again. But I'm wondering – I'm 57 and relatively healthy, when is it a good time for me to start thinking about what my wishes are? I don't even know where to start if I were to do this, can you give me some guidance?

The answer: When I was a resident working in the hospital, I often encountered patients who either had no one present to express their wishes for them; or as in your situation, had family close but their wishes were unclear as they had not been previously discussed. Being in the hospital is already stressful and when end of life decisions need to be made, an already overwhelming situation can feel worse. For many families, these scenarios can lead to conflict, divide families and leave the wishes of the incapacitated person unfulfilled.

It is often only when we or a loved one are faced with illness or injury that we think of end of life issues. While it can be uncomfortable to discuss – illness, injury and death are inevitable, so I encourage you to start the process now, regardless of your age or health status. The benefit of giving it attention at a time when you have control over the situation greatly outweighs the discomfort.

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Having the conversation while you are able to clearly state your wishes increases the likelihood that they will be respected if there comes a time when you are unable to express them. Secondly, it is easier and more comfortable for your loved ones to act in accordance with what you would want done.

Once you have a discussion with your family and friends, consider writing down your requests in a form known as an advance directive or a living will. This is a written document that states what your wishes would be for health care interventions. It can be overwhelming to think about what details to include, so consider getting advice from your doctor as to the specific language that should be used. Specific topics to consider include what you would want done if you need to be resuscitated or be sustained on life support.

Also, choose someone who can act as a proxy for you. Depending on what province or territory you live in, there are different names for this proxy, but often it is referred to as your power of attorney. Naming a power of attorney is a legal process that gives someone else the right to act on your behalf. You need to find someone you trust but also a person who is willing to take on this responsibility.

There is no central registry where the government stores these directives, so be sure to let your loved ones know where the documents are in case they are needed. While not required, you may also choose to involve legal counsel to ensure that they are completed properly. Alternatively, there are resources and preset forms with instructions that are available through each province or territory's attorney general website.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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