Death with dignity

April 26, 1994

Richard M. Nixon's last contribution to the nation may be the manner in which he died. By instructing his family and doctors in advance that he did not want his life prolonged by futile treatment, he has set an example the rest of us should follow. There are several reasons: relieving the stress on surviving family, avoiding the agony of prolonging the motions of life, and reducing the demands on the health care system for sophisticated, expensive treatment that simply postpones the inevitable.

Like the former president, Marylanders have the opportunity to make their own decisions about the sort of life-prolonging care they want -- and don't want. As he did, they can prepare instructions in the form of living wills, or designate a person to make decisions on their care according to agreements made in advance.

The value of selecting a health care agent who understands the patient's wishes lies in its flexibility. An agent can make decisions according to the specific circumstances that arise, even one that could not have been anticipated months or years before. Living wills are useful documents, but they may not anticipate all the factors that come into play at the end of a life.

As health care costs soar, creating pressures to bring them under control, the expense of heroic measures at the end of life must be calculated by society. No one begrudges all the advances of medicine to any person whose quality of life can be sustained through medical intervention. But heroic measures don't always produce miracles. Indeed, too often they result in vigils that can exhaust a family's emotional and financial resources. Public opinion polls find that increasing numbers of Americans fear dying -- not death itself so much as the high-tech nightmares that too many people endure.

Courts and legislatures have recognized the right of Americans to address these issues in advance, allowing them to lessen considerably the stress on family members when emergencies arise. Some of these wishes can be stated specifically on forms available from the Maryland attorney general's office; others can be made easier by communicating general preferences -- ideally in writing -- to a designated family member as well as to principal care-givers.

Richard Nixon was a fighter all his life. Few people in public life came back so often from what had once seemed to be fatal political setbacks. That a man of this caliber chose not to survive a massive stroke at all costs is a significant lesson for us all.

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