It was a surprise when I first offered a class on dying and death to find that it attracted large enrollments, creating waitlists well beyond the limit of 30 students. It remained the most popular course I offered for over a decade, right up to my retirement. Undergraduates thirsted for open discussions of the end of life. Yes, they wanted to learn about the remarkable diversity of cultural customs associated with death, but they also wanted a safe space to talk openly about their experiences of loss, grief and fears of facing their own mortality. They also wanted practical knowledge about the moral and legal issues that swirl around life’s ending, from physician assisted death to funerals, wills and trusts. It was clear to me from the start that the course had to roam well beyond the disciplinary confines of my academic field, anthropology, and that I wouldn’t enjoy the comfortable expertise that usually accompanied my teaching.
I embraced my students need for practical knowledge about dying and paid special attention to their worries about losing control over life and death decisions. With just a layperson’s knowledge, I directed them to resources for legal documents like Durable Power of Attorney for Healthcare and Advance Healthcare Directive (Living Will). We talked about how important these legal protections are not just for each of us but for our loved ones, and urged each of them to have a full discussion with their parents about their wishes. I also encouraged them to access information about last wills and testaments and recounted my experiences both serving as the executor of my mother-in-law’s will and helping my wife with the torturous path through a sibling’s death when there was no will.
A former student sent me an email years after graduating. She recalled the class and wanted me to know that it had been helpful: “You were with me this Fall as I cared for my father who died last month. Taking your 2003 class on dying and death guided my whole understanding of how to approach end-of-life care. Thank you for helping me have the confidence and terminology to advocate for his quality of life. Because of your class, we had already had all of the important conversations years ago. I knew what he wanted even when he couldn’t express it. I am indebted to you for that gift of time and clarity.”
Her kind reflections reminded me of how important it can be to just open the door for difficult conversations. I hope she has also considered how she can manage her own life and death decisions — it isn’t just about our older relatives. In particular, I urged all my students to complete the only form that is designed to convey choices in emergency situations, the Medical Orders for Life-Sustaining Treatment (MOLST). As my primary physician explained emergency medical technicians will attempt resuscitation regardless of what a health care proxy or advance directive may indicate. Unless someone starts chest compressions immediately, that may result in outcomes we would not choose.
If the heart has stopped and blood flow interrupted for four or more minutes, permanent brain damage will result even if cardiopulmonary resuscitation restores a pulse. Survival to discharge from a hospital after CPR that occurs outside a medical setting is vanishingly low, only 10% of patients, and even those persons suffer serious disabilities. Given that response times, especially in rural Franklin County towns, are unlikely to result in treatment in less than several minutes, this reality may conflict with personal choice. The MOLST form, now accepted in every state, is the only way we can enforce limitations consistent with our wishes in emergency situations. EMTs must abide by what the form specifies so long as it is available to them.
In the spirit of continuing to encourage choices about the end of life, I would urge readers to consult with their primary care physician about the MOLST form. It is simple to complete once you are clear about what you do and don’t want done in emergency situations when you are unable to speak for yourself. Your physician’s signature on the form is required. As I did for generations of college students, I want to promote individual free will informed by medical knowledge. We save both ourselves and those who care about us untold sorrow by making sure that our wishes are known and followed. Complete the form with your doctor and then revisit it from time to time to make sure your choices remain the same.
Donald Joralemon, emeritus professor at Smith College, lives in Conway.