First, I want unlimited painkillers


A medical expert talks about why you should stop postponing writing that living will


It was after she gave CPR to a cancer-ridden 84-year-old woman that Dianne Godkin started thinking about a new, more academic direction for her nursing career. She was working in Alberta at the time. “As I attempted to breathe life into her limp body, my lips came into contact with hers—blue, clammy, cool and lifeless. My physical response was immediate and caught me off guard. I rushed to the staff bathroom where I vomited.”

Godkin learned later from the woman’s family that “the unspoken goal of her care for the remainder of her days was to have been comfort.” Instead, “the inert woman was stabbed with large-bore needles, zapped with electricity and physically battered with chest compressions by a roomful of strangers.” Godkin believed she had “personally contributed to a system that failed to provide the best possible care to a patient.”

The violence of the event led Godkin to write her own living will. Now she’s published a guidebook for anyone who feels the way she does about wanting control over the treatment they receive at the end of their lives.

First off, she says in Living Will, Living Well, you don’t need a lawyer to write such a document, but it must be witnessed by two people. If you hate country music and don’t want to hear it played in your nursing home room, write it down. If you loathe the colour purple and don’t want to be dressed in it, say so. Make sure your family doctor gets a copy.

Procrastination, she says, is a major reason why more living wills aren’t written. “Emotions arise,” explains Godkin, who was surprised that her 2V2-page document took eight months to write: “I kept putting it off.” She isn’t the only one. For her Ph.D. disser-

tation, Godkin followed 15 elderly Canadians as they got their papers in order. One woman feared, “If you stipulate that you never want to be put on life support, I might get dead quicker than I was supposed to.” “The most important thing,” emphasizes Godkin, “is the conversation you have with the person you’ve chosen to be your substitute decision-maker. Writing it down is to help guide the person who is making the decisions for you.” Godkin has let it be known that “if I can’t communicate or interact with my environment in some meaningful way, I wouldn’t want treatment.” If she got pneumonia, for instance. “I wouldn’t want to be transferred to acute care. I would want to die wherever I was, type of thing.”

Another woman put it this way: “I don’t want my life to continue if I’m in severe pain or comatose with no reasonable hope of recovery. Second, I don’t want my children to be forced to tell the doctors to pull the plug on their mother. They seem to have a hard time recognizing when enough is enough. I know it’s their training to save lives, but I’ve lived a good life. It’s okay for them to let me go.” One person in the study stipulated he didn’t want to be in pain. “If I couldn’t manage the pain myself, I would want painkillers without some staff member worrying

about whether I was going to get addicted

because that’s just ludicrous to worry about addiction when someone is dying.” “Without exception,” writes Godkin, “everyone I talked with had seen others, most often close family members, suffer at the hands of health-care professionals. Some told stories of invasive surgeries being performed. Others told anecdotes about family members whose lives were forever changed when resuscitation measures were used against their wishes and the patients sustained significant brain injuries from which they never recovered.” The default position in most hospitals is to resuscitate “if we don’t have directions to do otherwise,” Godkin said in a phone interview last week from her new post in Toronto as manager for the Centre for Clinical Ethics. The Alberta woman who made Godkin start thinking about the issue was without a written Do Not Resuscitate (DNR) or No Cardiopulmonary Resuscitation (No-CPR) order.

“I’ve heard nurses joke about having ‘NoCPR’ tattooed on their chests,” she said. “CPR has a very low outcome in terms of success rate, more like four to 20 per cent. Unless it’s done very quickly, brain damage begins in about four minutes.” CPR was never intended for the terminally ill, she says. It was intended for sudden cardiac arrest, drownings and electrocutions. “It’s ironic,” Godkin says, “to consider that life-saving technologies developed to benefit humanity and to support life have become the enemy when

death is imminent." M


She never completed high school but she’s still managed to make millions, so she must know something. Last week, Quebec City’s Université Laval recognized that something by awarding Dion her first honorary doctorate. From now on it’s Dr. Dion to you, and you’d be wise to listen to her insights: “If there is something that has guided my life, it’s my wish to excel and go further, to the maximum of my abilities, to the top of my goals and my dreams.”