To the editor: As an end-of-life doula, I appreciated nurse Kristen McConnell's poignant piece on the importance of and value in making end-of-life decisions before major illness, accident or death occurs. Everyone needs to hear this message. ("Why you should make end-of-life care decisions now," Opinion, Dec. 26)
Talking about death and end-of-life issues is challenging because our culture generally does not support openness about this most inevitable part of life. I encounter many people who are hesitant to start or even complete their advance directives and other end-of-life documents. But avoiding these conversations won't stop death from happening.
There's a lingering myth that discussing death is a kind of morbid jinx — that it may bring death on prematurely. This simply isn't true. Getting our advance directives and other end-of-life documents in order is essential. It is an act of love and a gift we give ourselves and our loved ones.
Sarah Farr, Silver Spring, Md.
To the editor: As a bioethicist and attorney, I have written about many complex end-of-life issues, including medical futility, patient autonomy, and sanctity of life versus quality of life, all of which permeate McConnell's article's poignant reminder for the need an advance directive (AD).
The basic concept of an AD is that we must indicate, while we are competent, our wishes about how we want to be treated if we become incompetent. Most important, the AD seeks to keep responsibility for decision-making with the patient.
A major problem is that many times AD instructions do not and cannot specify all possible circumstances and conditions of the patient; hence, there is an element of ambiguity, and designating a particular individual as a surrogate decision-maker may alleviate some of the uncertainty.
Nevertheless, the AD is an invaluable instrument, so take the necessary steps and plan ahead.
Richard Boudreau, MD, Marina del Rey
To the editor: McConnell makes a powerful argument for determining for yourself how you experience your final days. I take one issue with her piece, however.
She compares her feelings of hopelessness and helplessness about caring for an end-stage human being kept alive only by life support to her feeling of "shame" when she walks by a "cold, crippled homeless person on the sidewalk." Both wrongs, she says, are obvious.
The cold, crippled person on the sidewalk could within a few hours be warm, placed on a medical or physical therapy plan to address and perhaps even cure his or her crippled condition, and be put on a path toward permanent housing. Such a person might have many more years of happy, productive life ahead.
We apparently do not have the political will in this country right now to transform homeless lives into meaningful lives. What will it take?
For starters, I'm looking to the 2018 election.
Eric A. Gordon, Los Angeles