SACO – Perhaps we can change the term “end-of-life choices” to “end-of-life living.”

We associate the term “end of life” so strongly with death that we forget that the end of life is equally about dying and living.

Indeed, these choices are about how we live life at the end. And we have more control than we realize.

My opinion about the article published in the Portland Press Herald on July 3 by Holly Ramer of the Associated Press about hospice care (“Hospice care evolves as needs emerge”) is that she is absolutely correct.

It will be the baby boomers — and I am one — who will raise our awareness. And subsequently the baby boomers will drive all of us to become educated about of end-of-life living.

My interaction with friends in the last stages of living show me that they are willing and desirous of less intervention to prolong life.

But physicians are very slow and reticent to allow a more natural death.

In fact, certain states, including Oregon’s form for physician orders for life-sustaining treatment, and many advance directives increasingly use the term “allow natural death” and use “DNR” (“do not resuscitate”) less often.

The problem with both terms is that neither is specific enough, although I like the positive approach of allowing natural death much more than the negative counterpart “do not resuscitate.”

I have been more specific in my advance directive about what allowing natural death means to me.

I have found many advance directives do not include specifics about many things including dementia.

For instance, my advance directive states in my own words that if I have dementia and cannot recognize by name or emotion my children or grandchildren, I do not wish to be fed unless I take the initiative and do so myself.

I do not know the requirements for a physician’s education toward practicing geriatric medicine.

However, it is my hope that there is movement that compels physicians to inform patients that there is always the option to refuse treatment.

When the medical community does not point this out, many of us are so emotionally involved that we forget this is even an option.

We plan ahead for our careers, vacations, families and home repairs.

We owe it to ourselves and those we love to also plan ahead for our end of living.

I speak of end-of-life choices frequently and often hear people automatically reply, “That’s all taken care of. I did that 10 years ago.”

If that is the case, planning for end-of-life choices is not addressed sufficiently.

Advance directives need to be reviewed and updated yearly.

As we age, our views change and medical advances change.

Therefore, we must take the time to make our advance directive current.

I do so on each Memorial Day. It seems to be fitting.

Ramer’s article is about the advances in hospice care.

I have long felt that hospice care needs to be more proactive in caring for those with congestive heart failure, as well as other heart diseases and dementia.

In her article, she states that this is indeed happening.

In the past, I have noted that physicians rarely inform patients that congestive heart failure is a terminal disease.

I hope this is changing as, in my opinion, this is a huge mistake.

We can make good decisions when we are properly informed.

When facts are not given to us, it is difficult to make appropriate choices.

On my desk is a notebook.

It is labeled “gniviL efiL fo dnE: End of Life Living.”

My daughter asked me to write the words backwards, perhaps to test my mental abilities, even now, or just to make me smile.

But it sits there for both my children and for me.

It is a reminder for me and for them.

It spells out exactly how I want to enjoy the end of my life.

It may not be exactly what happens, but life never is.

However, it is the best effort I can give and knowing that, I will continue to review the contents each Memorial Day.

We can choose to live life to the end as we direct.

Hospice care is becoming more and more active in that process.

It is incumbent on each of us to educate ourselves about end-of-life living and choices. As long as we keep asking questions and become informed, we can live our lives to the fullest.

– Special to the Press Herald