My wife and I sat at our kitchen table a few days ago and decided how we want to die.

If this scene seems swabbed with melodrama, I need to offer a disclaimer. It didn’t feel that way.

If there was an atmosphere in our discussion, it was a mix of solemnity, real time pragmatism and an overlay of relief. It forced us to make some choices that were not dynamically clear and self-evident. But what significant parts of life are? What we were trying to do was to perform a civilized service to those closest to us and to ourselves.

There was one other mood at our table, if you’ll allow me; this was a gratitude for the opportunities of life and the wonder of it, from its very beginning. I think both of us understood the respect for life that we wanted to bring to this discussion of death and how it is accepted. I’m sure we added to this some unspoken reflections we couldn’t escape. They were private, wistful nods to some of the horrendous blunders and occasional wise turns we have made in our separate lifetimes. But that was about life and being human. What we were talking about now was the most human way to look at the end of life.

I think that was the spirit at our table. What was in front of us were options—our wishes—in how we prefer to die if and when those options are available. They will guide doctors and courts of law if necessary, but mostly they create unmistakable compass for people we trust if we’re incapable of making those decisions in extremity.

The turmoil surrounding the final days of Terri Schiavo moved millions of Americans like us to consider the terms and conditions of our final weeks and hours. It’s something seductively easy to postpone and almost all of us have done it. It’s not hard to find a few thousand better ways to extract some amusement out of the day. The problem is that delaying it indefinitely puts us into a punishing endgame in which those most likely to absorb the punishment are the ones who survive us.

In front of us was a health care directive, a suggested form, prepared by the extension service of the University of Minnesota. Because its completion requires the signature of a notary and two witnesses, it serves the same purpose as the document widely known as a Living Will. It requires us to designate an agent to act as our surrogate when decisions need to be made that we can’t make for ourselves, or to specify dual agents and/or alternates and in what order they are to serve as our voice if it’s possible for all of them to gather. The language of the directive is simple, sensible and straightforward. It tries to cover all contingencies but above all it tries to avoid the intramural warfare we witnessed in the Terri Schiavo saga.

In part, it says this: The agent should be someone “you trust, has similar beliefs and values about medical care and death of dying OR is willing to carry out your wishes even if they are different from his or her own; is not easily intimidated by family members, friends or health care providers; will be an advocate for your interests; can cope with making difficult life and death decisions including making decisions that allow you to die, and can make decisions under stress.”

This does not define a super creature. It simply describes a person to whom you have confided your wishes when life-or-death decisions need to be made. This is somebody you trust to insist on those wishes if and when the hour comes when black and white blur into shades that unless resolved can transform a solemn hour into an ugly family brawl of competing sanctimonies.

You are asked about some of those shades. How do you respond to them now, when you can sift calmly through the options? On the scale of 0 to 4 (0 being not important and 4 being extremely important) how important to you is being as comfortable and free from pain as possible? Well, yes. Who wants pain when you can avoid it. Put one large X under 4. But now this: How important is the Use of Life-Prolonging Treatment When:

Is life-prolonging treatment in those conditions important to you, somewhat important or not important at all?

Would you, under comparable conditions, wish to receive the support of a breathing device, a feeding and hydration tube that could keep you alive indefinitely, or action to restore the use of your heart and lungs if they stop functioning?

These are questions you are not likely to answer instantly. The directive in front of us has tried to define these actions and what they mean, temporarily or longer. It counsels talks with health care professionals if we are not sure. It asks us to inform the readers of the directive of spiritual beliefs that might affect our health care. It asks us to express our feelings about certain medical treatments. The advice in it is thoughtful and neutral. It is not beyond argument, but what legal document is?

In the end, all we reasonably can do is to make our wishes plain and our trust unquestionable. We are human, vulnerable to doubt and sometimes blessed by it. It’s hard for me to forget the interlude in my mother’s home more than 15 years ago. She was in her 80s, having lived alone for years in northern Minnesota after the death of my father. She was still lucid then, and understood the idea of a living will when my brother and I suggested that she consider it. We went through the questionnaire and she replied positively to each question, affirming her wish not to be kept alive through heroic measures if her condition was terminal until—

We came to the question of a feeding and hydration tube that could be removed if there was no further hope of her survival. She was silent for a few moments and then asked us to explain what that meant. We said it meant withdrawing water and nutrition if her case were hopeless. She looked distressed. We didn’t have the knowledge then to explain that this would be done in cases where the brain could no longer transmit pain or discomfort, as the preponderance of medical authority did in the Terri Shiavo case years later.

“I’d rather not sign this,” she said finally. “Is that OK with you?” We said it was. She smiled, almost in apology. “If the time comes,” she said. “I know you’ll do the right thing. You’re all that I have and I trust you.”

After three relatively comfortable years in a home for assisted living in Minneapolis, she was transferred to a hospice and drifted away peacefully and, as far as we know, painlessly. No heroic measures were needed nor asked. But death often can be more complicated than that, and the doubts hovering over it anguishing and divisive. Coming to grips with our wishes for our final hours, and doing it an atmosphere free of contention, is not an exercise in morbid prescience. It is an act of thanksgiving for the life we have been given.

---Jim Klobuchar

© 2005 Jim Klobuchar