Legacy: What Will Your Verse Be?

 

In keeping with my recent focus on issues of aging, my blog this week comes from change management consultant, Jann Freed, whose most recent book looks at aging with wisdom, or “sage-ing.”

 

legacyWe often think of a legacy as something that emerges at the end—the end of our lives, the end of a job, the end of a career.  But in reality, we leave our legacy daily with what we say, how we say it, and what we do.

I like to ask:  Are we living our lives in ways we want to be remembered?

After the death of Robin Williams, people reflected on his many movies.  While I loved Good Will Hunting, my favorite movie was Dead Poet’s Society.  As someone whose first career of 30 years was that of a college professor, I was enamored by the way in which his character, John Keating, engaged the students in learning.  Here is one of my favorite lines from that movie:

“We read and write poetry because we are members of the human race and the human race is filled with passion. Medicine, law, business, engineering, these are noble pursuits and necessary to sustain life but poetry, beauty, romance, love, these are what we stay alive for. To quote from Whitman, ‘O me! O life!… of the questions of these recurring; of the endless trains of the faithless… of cities filled with the foolish; what good amid these, O me, O life?’ Answer: that you are here; that life exists, that the powerful play goes on and you may contribute a verse. What will your verse be?”

 

What is your verse now?  

We often think of legacies as positive—people who have made a positive difference.  But legacies can also be negative and it can happen fast, as we witnessed with Coach Joe Paterno and even more recently with Bill Cosby, whose legacy went from great to bad almost overnight.

Yet, legacy thinking is forward thinking.  When we are intentional about our words and actions, we are anticipating how we affect others.  Many of us do not have the money and influence to have our name on a building, an endowment, or a stadium named after us.  But are we leaving the world a better place?

When talking about legacy, I advocate writing an ethical will, which is more than a legal document that describes how we want to allocate our financial and physical assets.  An ethical will (www.ethicalwill.com) is a document that communicates our values, beliefs, and other stories that we want to pass onto others.  Sometimes this document is referred to as a legacy letter, but the intent is the same—to share with others what matters most to us.  An excellent book on ethical wills is titled So the Tree Grows—Creating an Ethical Will—The Legacy of Your Beliefs and Values, Life Lessons, and Hopes for the Future by Jo Kline Cebuhar.

Since many families are scattered and most of us are not sitting around the kitchen table every week sharing stories, being intentional about what you want people to know is important.  When I realized that my sons kept the notes, letters, and cards I sent them at camp, during college, and beyond, I have started writing them “legacy letters” on their birthdays.  While I don’t call them that, I write the letter with the mindset that I am sharing what I want them to know and remember right now.  As they have gotten older and grown in maturity, the subject matter changes.  This has been a nice tradition—whether they realize what I am doing or not.

As Barry Baines, the founder of “EthicalWill.com” says:  “We all want to be remembered and everyone leaves something behind.”  It is the little things that can make a big difference.  Being intentional and thoughtful helps give purpose, meaning, and direction to our life.

So rather than drift with the wind, I challenge you to think about how you want to be remembered.

What will your verse be?  

 

Jann Head ShotIn Jann’s first career as a college professor of business management, she held the Mark and Kay De Cook Endowed chair in leadership and character development at Central College in Pella, Iowa.  She retired in 2011 as professor emerita and is now a leadership development and change management consultant with The Genysys Group.  She calls herself “The Transitionist” because her focus is on helping organizations and individuals get from where they are to where they want to be.

She is the author of five books and the latest is titled Leading with Wisdom:  Sage Advice from 100 Experts. If you want to explore how some of our great leaders have created a legacy, you might enjoy Chapter 9, which is titled “Leaders Live Their Legacy.”

Thoughts on the “End of Life”

 

What is your definition of death? Is it the same as “the end of life”?

End of LifeBased on survey responses from the participants in my seminars on the Bio-Ethics of Aging, the answer depends on whom you ask. What stands out, from their responses, is that discussions of end-of-life issues are fraught with potential for misunderstanding, as the same words mean different things to different people.

For example, most participants defined death in terms that pointed to the cessation of lung and heart function.  A few defined it as the cessation of brain function. Both are accepted medical criteria, but they can result in very different conclusions in different circumstances. Moreover, under current medical practice, policies and procedures to establish the time and fact of death may vary from state to state and from hospital to hospital within each state.

What counts, when you are facing the actual or imminent death of a family member is not your definition of death, but the opinions of your doctor and/or the policies of your hospital. Do you know what they are?

By contrast, the respondents offered definitions for “end of life” that covered a much broader spectrum.  A few individuals defined it in medical terms, often based on religious beliefs.  What I had not expected was that so many participants would define it in terms of the ability to engage in everyday activities—and that there were almost as many definitions as there were respondents to the questionnaire.

For example, some defined it in terms of the end of “useful life”—the inability to contribute in some way, be it financial, emotional, or simply helping with the grandkids. Others defined it in terms of loss of dignity, e.g., the point at which you can no longer take care of yourself. Some defined it in terms of the mental or physical capacity to participate in everyday activities at some—for the most part, undefined—level.

What was clear, from these responses, was that not being dead was not the same as being alive. But these definitions left many questions unanswered, and offered little guidance for someone having to make a decision about a medical treatment that would prevent biological death, but would not return your parent or spouse to the kind of life they wanted.

The issue matters.  I know from painful, personal experience that it is so easy, when you’re struggling to cope with a traumatic situation, to let your physician make all the decisions. When my mother fell and broke her hip, her Alzheimers had already advanced to the point where she could not reliably dress, bathe or get herself to the bathroom. She was not dead, but neither was she alive by her definition; her wish to be dead in that situation was very clear.

Even so, she was sent automatically to the hospital, where I seemed to have no choice but to authorize surgery to repair her hip, an operation from which she never recovered enough to even use a walker. She was even less alive than before the surgery.

The incident prompted my brother and I to research our options in the event of additional trauma.  Our decision, with which many may disagree, was that we’d keep her comfortable but would not authorize any treatment that required hospitalization or would delay the death she so clearly wanted.

When my mother’s physician disagreed, we found a new physician who shared our point of view.  To this day, however, I cringe to think of how it difficult it would have been for my brother and me if the first we learned of our doctor’s definition of “end of life” was when my mother was a candidate for treatment of cancer or a urinary infection … and when we did not yet know what our legal and medical options were.

If you’ve never talked about this with your family or your physician, maybe it’s time.  What most of us want, when an end-of-life occasion arises, is the ability to deal with an already difficult situation with love, compassion and the certainty that you are doing the “right thing.”  Are you prepared?

The Right to Decide

 

medical_heartMuch of the focus of the seminar I teach on the Bio-Ethics of Aging relates to the distribution of health care in a world of finite resources.  An equally important issue, based on the responses of the participants during the three sessions, is the nature and scope of one’s right to decide how to die.

In this context, I would note that the initial impetus for my interest in bio-ethics was the prolonged and painful process of dying suffered by both of my parents.  My father, a devout Catholic, was bedridden and in pain at age 54 with the gruesome complications of diabetes. While his faith made it impossible for him to “hasten” his death, he repeatedly expressed the desire to be allowed to die. The last and most tragic chapter of his illness was that four of the five times his heart failed, his doctor took extraordinary measures to get it pumping again.  When resuscitation failed the fifth time, I mourned loss of his life, but celebrated his death. Legally, he had the right to decide to die a year earlier, but he did not have the stamina to overcome his doctor’s refusal to let nature take its course.

The situation was quite different with my mother who hung in there until a week before her 90th birthday. A talented, capable, vibrant woman who romped through eight decades with élan, she made her end-of-life wishes known when she was 70 and still outrageously sound of mind.  She handed my brother and me each a packet containing detailed instructions from the Hemlock Society, a guidebook for “hastening” her death if she was terminally ill and could not manage for herself.

Her wishes were excruciatingly clear. But in 1985, who knew about Alzheimers?  Her advance directive did not include brain plaques as a “terminal” disease that would trigger her living will.  And even if it had, the laws of the U.S. made it impossible for us to honor her wishes and preserve her dignity during her last decade. No longer of sound mind and increasingly unable to take care of herself—the essence of what she wanted to avoid—she did not meet the requirements of those few states that provide for physician-assisted suicide. The tragedy of her illness was that her occasional flashes of coherence—when she begged to have us end it for her—were far too fleeting to meet the legal requirements in even the most compassionate of states.

And so, a decade after my mother’s death, I’m doing my small bit to prevent others from having to endure the painful and prolonged process of dying that my parents went through. In theory, each one of us has the legal right to decide whether to accept or reject health care. Unfortunately, many do not realize that this legally enshrined principle of “patient autonomy” gets short shrift in far too many cases.

One of the prime offenders of patient autonomy, as I saw with my father, is the medical profession. As Atul Gawande observed in his recently released and not-to-be-missed book, Being Mortal, “the way our professors saw it, the purpose of medical schooling was to teach how to save lives, not how to tend to their demise.”  But death is an inevitable part of life.  Medical advances can make our lives longer, but they cannot “fix” the fact of our mortality. What is to be hoped is that more and more members of the medical profession will learn to help us live a good life and then die a good death.

State laws also conflict with the concept of patient autonomy and the ostensibly legal standing of an advance directive. The five states that allow “physician-assisted” suicide do so only for patients who have the mental capacity to articulate their desire to die in the presence of two separate physicians, as well as the physical capacity to self-administer the medicine of choice. The mental capacity without the physical ability is not sufficient. An advance directive that explicitly documents the desire for death in the case of mental incapacity is not sufficient.

As I contemplate my next novel, I know that end-of-life issues will be a key plot thread, and the source of a broad range of conflicts between my characters.  Over the next year, I anticipate doing a series of blogs on health care issues, blogs that raise critical questions for which there are, at present, not very many answers.

I hope you will find the questions helpful in finding your own answers, in exercising your own right to decide.

 

Modern Medicine-A Curse or a Cure

 

Bio-Ethics of AgingFor the second time in two months, I am teaching a three-week class on the Bio-Ethics of Aging. For the second time in two months, I am struck by how little thought otherwise knowledgeable and well-read people have given to the health care and end-of-life issues the baby boomers have to come to grips with as they age.

One of the key questions that we deal with is whether end-of-life decisions should be made by you or by the medical community.

I was thrilled when my one of my favorite bloggers and writers, Joan Z. Rough, asked me to do a guest blog for her on aging and end-of-life issues. The timing of my blog for coincided with the very public death of Brittany Maynard, the very public discussion of end-of-life issues for a young Iowa woman suffering from brain cancer, and the rather more private but intentional death of an older woman I have admired for years.

It is a blog I would have put here if I had not already committed to publishing it on her site.  I hope that you will visit Joan’s website to read my comments.

Here is an excerpt from that blog to tempt you …

As recently as 200 years ago, if you stopped breathing, you were considered to have died, whatever the cause. There were few scientifically based options to prevent or delay death.

A watershed moment in the history of medicine came with the invention of the stethoscope in 1816 and the ability to register a heartbeat. But there were still no science-based treatment protocols.  For the next century, death continued to be, as it had been for much of the history of mankind, a part of “God’s plan” or—if you were of the atheistic or pagan persuasion—a matter of fate.

Until 1928, that is, when Alexander Fleming discovered penicillin. Suddenly, man no longer had to rely on God or fate to determine the outcome of an injury or an infection. Over the last 90 years, our ability to triumph over illness has expanded exponentially.  Today, we can prevent most infectious diseases (Ebola being a notable exception), repair a faulty heart, excise a malignant tumor, or replace a failing kidney.

For much of the 20th century, these medical advances focused on preventing “premature” death from infection, disease or trauma. But these often seemingly miraculous discoveries had a number of unintended consequences.  For one, the medical advances that keep young and middle aged Americans healthy have played a major role in the explosion of health care costs for the elderly. By preventing or curing acute illness, we have expanded the population vulnerable to chronic illnesses such as diabetes or COPD, many of which cannot be cured at all and are treated at great cost.

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