Letter to my children and physician about my end-of-life wishes

In the last two years, I have had the deep privilege of walking beside over a dozen families as their loved one declines on hospice. There is no way around it. This is emotional territory. What can complicate it is if family members and/or caregivers are not clear on what their loved one’s wishes are or have differing opinions. A number of hard questions can come up, like does dad want tube feedings or to be hand-fed when he can no longer eat? Does mom want to be put on a ventilator when she can no longer breathe? There are no easy answers.

That said, I had the honor of walking this journey beside one wise, life-long physician who wrote the following letter expressing his wishes. Having taken care of thousands of patients over the course of his forty years as a physician (the last ten years in a nursing home), he well knew the consequences of not making one’s wishes known. His family gave permission to share his letter with the hope it may spur helpful conversations before they arrive in this fraught territory.

To my wife, my children, and any physicians, surgeons, attorneys or court officers who may become involved in my medical care in the future,

I would like to express my clear desire, should I be incapacitated by some illness, accident or unforeseen event at some time in the future to the extent that I am not able to communicate my thoughts or desires, not to have my life prolonged by what I consider artificial means, such as pulmonary ventilation, tube, parenteral or hand feedings, etc. if there is no reasonable hope that I will be able to recover and again lead a reasonably active and enjoyable life in the future.

If in the opinion of competent physicians and consultants, it seems highly improbable that I would recover to the extent of being able to communicate with my family or to care for myself to a large extent, or to take nourishment by my own hand, I would prefer that all means of prolonging my life, such as intravenous fluids, tube or hand feedings, pulmonary ventilation, antibiotics and even my pacemaker, be discontinued (or in the case of my pacemaker deprogrammed), that I be kept comfortable with means that are readily available and that I be allowed to die in a reasonably dignified and natural manner.

I do not consider that merely existing without cerebral function or without voluntary and controlled physical activity is worthwhile, and I do not feel that anyone caring for me should believe it necessary to prolong such an existence in my case. I am well aware that competent physicians, at least after reasonable time, can come to some conclusion as to whether there is any possibility of significant improvement and restoration to a satisfactory quality of life, and that such physicians should be relied upon for a prognostic opinion. In other words, I do not want to be kept alive in the hope that some miracle will occur which will restore me to a useful life.

Signature of physician who wrote this letter

Signature of Witness #1

Signature of Witness #2