Lifelong Health by Dr. David Lipschitz

Can a week be worse? A woman whom I was very close to died in her mid-90s. For me it is a terrible loss, and the frequent comment "that her death was a blessing" or "she had lived a long and wonderful life" does not ring true. I will miss her, our visits, the sage advice I frequently received from her, her stories and her wit.

At her funeral, my sister called from South Africa. My mother had just had a stroke and could not speak or walk. That day I left for South Africa, and I write this column from my sister's house.

My mother turns 90 in June. She has embraced life to the fullest, is a world-class bridge player and was never without a man on her arm. She remained full of vim and vigor, loving and healthy until that first Monday in September when she had a serious fall. She broke her shoulder, her nose, but most significantly, her hip.

After surgery and rehabilitation, she seemed on the road to recovery. A month later she developed a serious gastrointestinal problem. While performing gastroscopy to look at her stomach, she had a cardiac arrest. No one thought she would survive.

But after a six-week hospital stay, she gradually recovered, went home and was able to walk with a walker. Two months later, she had her first stroke. This affected the left side of the body. Although walking was virtually impossible, she remained as sharp as a tack and was able to get about in a wheelchair and communicate.

And now the final blow. Seeing her breaks my heart. She cannot speak, does not understand and cannot move without being carried from the bed to a chair.

My mother does not have a living will. We never discussed her wishes should she become so seriously ill; she always seemed so healthy and invulnerable. This circumstance creates huge dilemmas for families, particularly if there are disagreements, conflicts and children are scattered worldwide.

Children may feel guilty and have different opinions on the value of artificial feeding. They question whether continued hospitalizations should be considered and if infections occur, should they be treated with antibiotics?

I have three siblings, and we know that my mother asked that she never be hospitalized again.

We have decided not to pass a tube into her stomach to feed her artificially. She is able to eat and drink with help.

We will provide as much comfort care as possible but will not do anything that will prolong life for more than a short while.

Because my mother is reaching the end of her life, my family has spent time discussing living wills and what constitutes a terminal condition legally and ethically. In the advanced health care directive that I have signed, the definition is as follows: "A terminal condition means an incurable and irreversible condition caused by injury, disease or illness, that would within reasonable medical judgment cause death within a reasonable period of time in accordance with accepted medical standards, and where application of life-sustaining treatment would serve only to prolong the process of dying."

And life-sustaining treatment is defined in part as follows: "to include, without limitation, any medical or surgical treatment, procedure or intervention that uses mechanical or artificial means, including but not limited to hydration, artificial respiration and cardiac resuscitation."

These are wrenching decisions for families. No matter your age, it is much more preferable to make your wishes known by having an appropriate living will. Importantly, assign a relative or close friend who will become responsible for decisions if you are unable to do so yourself.

Without a living will and if the family cannot agree, the health care system may have no choice but to be unduly aggressive. This can be prevented if all family members know of their parent's wishes and if there is total consensus on the treatment plan.

If this is accomplished, recriminations and regrets will be avoided.

Involve your physician in the decision-making process, become as knowledgeable as possible about the illness and its prognosis and consider what you would want done were you in your loved one's condition.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at: www.DrDavidHealth.com.

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