I’ve heard much talk about silver linings in this dark cloud we call the COVID-19 pandemic. Traffic is lighter, for instance, and there’s less pollution. We’ve got more time to read and we’re learning to Zoom with grandchildren. Let me add one more: Many are thinking more deeply about their own mortality.
In ordinary times, few people I know think about their own deaths on a daily basis. But facts about the pandemic are hard to ignore: Older people and those with certain chronic conditions are at highest risk of dying from COVID-19.
The news reminds us that life is short, death is real, and we can find meaning in simple blessings. I think of a quote from Ronald Blythe’s The View in Winter: Reflections on Old Age. “What does it feel like to be nearly 100 years old?” the shepherd’s widow asks. “You wake up and say, ‘Still here?’ Then make the tea.”
People also seem more willing to contemplate their wishes and plans for late-life care and end of life. Health care providers report that since COVID-19 emerged, increased numbers of patients have completed advance directives such as living wills and durable powers of attorney for health care. Such documents help patients to be more intentional and communicate their choices around accepting or rejecting care and to appoint others to make care decisions for them if they are no longer able.
This activation is a good thing. It’s as though we’re finding a new metaphor for death. Given there’s no way to win a “battle” against aging, we’re burying the hatchet in a manner that puts health care providers, patients, and the true nature of life and death all on the same side.
I have long urged my patients to complete advance directives and to share such documents with their relatives and health care teams. I began doing so years ago after witnessing too many situations where patients suffered unnecessarily near the end of life because providers and family members simply did not know what a gravely ill person wanted. Uncertainty can lead to prolonged care that has little or no value. Advance directives can prevent this—especially when they include specific guidance about what a person wants and does not want.
So my advice during this pandemic is the same always: Be sure you have an advance directive that truly expresses what you want. Keep in mind that your ideas and preferences may change over time or according to your circumstances. If you completed your advance directive some time ago, you might want to revisit it, just in case your views have changed.
And remember, an advanced care plan is only that—a plan. In addition to documentation, we need real conversations with our physicians, other caregivers, relatives, and friends to inform our decisions.
Help to frame such conversations is available from organizations such as Compassion & Choices (www.compassionandchoices.org), which provides a comprehensive guide to help people explore their values and develop legal documents to describe their wishes. The site also provides tools for talking about end-of-life care with your family, friends, and health care providers.
I have observed that taking such steps can lead to greater peace of mind, which is something all us can appreciate during these extraordinary times.
Dr. Eric B. Larson is a senior scientist at Kaiser Permanente Washington and author of Enlightened Aging: Building Resilience for a Long, Active Life (Rowman & Littlefield, 2017).