I spend a lot of my time asking myself questions which explore the relationship between death and power. One of those questions is: How can people gain power over the processes and decisions involved in death, dying and the end of life? (Without opting for suicide or euthanasia)
I found one answer not from a modern textbook, but from a more ancient source. According to Judeo-Christian tradition, “death and life are in the power of the tongue” (Proverbs 18:21). Now, I’m no middle eastern religion scholar but allow me to give one possible interpretation of this adage- Maybe our abilities to communicate give us the power to create and control our lives and ultimately our deaths.
Certainly in a general sense, those who have the most power in any sphere are usually those who are the best communicators (i.e., President Obama) or those who facilitate or magnify communications (i.e., Mark Zuckerberg, the creator of Facebook).
Extrapolate this out to death and the end of life. Those who hold the most power over death and dying processes are those who are able to best communicate about it (hopefully, you, my reader) and those who are best able to magnify or facilitate communications about it. (i.e. Dr Ira Byock, the POLST movement, and the CAPC gang to name a few).
So let’s say that you want to gain more personal power over your end of life pathway….how would you do that? Communicate about it. It’s as simple as opening your mouth. Talk. Ask questions. Express concern. Yell out loud. Hopefully not too loud, but you get my point-the more you discuss something, the more you communicate about it, the more control you will be able to gain over the situation.
Alright, here are two examples to prove my point:
Imagine that your most vocal sister shows up at the bedside of your dying, unconscious father (or brother). Guess who is probably going to run the show from that point on? (Unless of course, you or your father (or brother) had previously communicated enough to set up an alternative healthcare power of attorney) Again see my point? The power is skewed toward the talker, the communicator.
Alternatively, imagine that you are at a doctor’s visit. Your doctor is doing all of the talking, while all you do is sit there and nod your head. Guess who is in control? Who has the most power in this situation? Hmm… This is starting to make some sense, right? In contrast, if I’m working in the ER and my patient asks a lot of questions, we begin to share power. Further, if this patient talks a lot about their ideas and goals regarding their care, then the patient ultimately gains the most power and I, the doctor, become more of a medical servant and advocate.
Now, maybe you are saying to yourself, “This is all fine and dandy, but I don’t know what to say” or, “I’m an introvert”.
What you are really telling me then, is that you are powerless. Guess what? I don’t believe that for one minute.
Anyone can ask themselves and answer the following question to increase their power over death, dying and the end of life:
“What is most important for me in my remaining time? (Be that 5 months or 5 years)
After answering this question, communicate with your healthcare providers that you want to choose medicine which will support you in accomplishing these goals. This form of communication will cause a major power shift in your medical relationships.
Think that was hard? Now I’m going to ask more of you. Not only should you master your own end of life communications and thereby, gain power- you should also facilitate others in doing the same. Lead by example. Yes, I’m asking you to become the “President Obama” or “Mark Zuckerberg” of end of life communications for your community and other social circles in which you have influence. Open up this conversation at family reunions. Title the reunion: “Please pass a burger and an Advance Directive”. Talk about your living will on Facebook. Tweet what you said to your doctor. Write a letter to your granddaughter detailing your life’s lessons and what legacy you wish to pass on to her. Email all of your contacts and tell them your goals for your remaining time; ask them to help you to make the end of your life become the best part of your life. I guarantee you they will help to make it so, and in so doing, will become inspired to gain control of the end of their own lives. Remember, Death and Life are in the power of the tongue, and the written word…and it all begins with you.
Reproduced with permission from Monica Williams-Murphy, MD of OK to Die.
For information about Dying Matters Week and the Dying Matters Coalition in the UK, visit the Dying Matters website.