Advance Care Thinking in the Age of Longevity

Further to my blog post on March 13 … “Empowered end of life care…”

Speaking for yourself

Planning for longevity, well into your 80’s and 90’s or longer, means anticipating good and not so good outcomes. It takes courage to ask yourself what care I want for myself when I can’t speak on my own behalf. That is a hard question to answer and sometimes disconcerting; so when you do come around to making some decisions, write your instructions down in a document called a Living Will/Advance Care Directive.

Often when people do think of what they want if hit with a sudden health crisis, they talk about wanting to take every medical step going. The term is “Heroic Measures” – but this is best for people who are reasonably fit and with few health complications. For a frail older person with osteoporosis, the outcomes are not good.

In the other extreme people will say something like, “I’ve had a good life – just let me go”. This term is “No Medical Interventions”, but this is too restricting. A better instruction is “Comfort Measures Only” which gives flexibility for pain management and other steps for easing discomforts.

When you can’t speak for yourself

Ask someone you trust if they would be comfortable being your spokesperson, a “Substitutes Decision Maker”. Give clear concise instructions with some leeway for unexpected complications and these must be legal. Discuss with your spokesperson, that as your life conditions develop you may want to change your instructions, and that you will always keep them up to date with any changes.

For added ease in this process, it is a good idea to have a backup spokesperson in case the first person is away or unable to respond in an emergency. Keep your back up spokesperson up to date with changes too. This is a safe action to take as a Living Will/Advanced Directive can only be used when you can’t speak for yourself. Have your instructions readily available, such as a small wallet card indicating that you have a Living Will/Advance Directive, available for printing at

A good precaution is never wasted

Everyone should have a plan. It’s a good life review exercise. While it may seem like a later life issue, the young (those over the age of majority) as well as the old can have episodes in their lives when they cannot direct their care. Severe flu, accidents, drug reactions, an epileptic incident and other temporary illnesses can cause disorientation or unconsciousness – and a Living Will/Advance Directive is there for you when you can’t speak for yourself on health care decisions.


Mary Ellen Tomlinson