Dying with Dignity: LGBT Couples’ Need to Plan for All Possible Futures

gay_flag-300x196It seems appropriate in a column titled “For Graceful Aging” that we should discuss “Dying with Dignity”: What are our options when aging successfully, healthfully, and happily is no longer possible?

Granted, we are opening a topic that many consider taboo.  But just as with all other aspects of aging gracefully and successfully, discussion and planning smooth the road ahead, so this may well be a discussion you want to have between you and your partner.  On the other hand, you may also  want to include several other people who are important in your life in the conversation.  So, where does the discussion begin?

First, understand that assisted suicide, sometimes referred to as “aid in dying,” is illegal in all but four states: Washington, Oregon, Montana, and Vermont.  Very few countries permit the practice.  New Jersey is one of the latest states to consider some form of legalized assisted suicide.  Jack Kevorkian famously, or infamously, went to jail in 1999 after helping an estimated 130 people in their efforts to end their lives.

Second, you may want to have this be part of a larger conversation between you and your spouse/partner and other loved ones.  That conversation should include legal documents, medical care planning, financial and long term care insurance issues, discussions about living arrangements and accommodations, quality of life, and many “what if” topics: What if you are incapacitated?  What if you have Alzheimer’s, ALS, cancer, paralysis?  What if you can’t take care of yourself or each other?  What if you can no longer stay together?

What is your threshold quality of life?  What is your partner’s?  How bad does it have to be before you would want it to end?  All are difficult questions.  All are important considerations.

According to LGBT Elder Initiative (LGBTEI) member Michael Clark, a nurse who served on the ethics committee of a university-affiliated teaching hospital for 20 years, “The two main issues faced by patients and their loved ones are symptom management, including pain, and quality of life.”  Clark says, “I think that the issue is best framed as promoting comfort and dignity to people with terminal illness who have the capacity to express their preferences related to the care that they receive at the end of life.”

Along with these most difficult discussions and decisions, talk to each other about your plans for successful aging.  Where do you want to live in retirement?  Do you want to age in-place?  Is a continuing-care or assisted-living community desirable?  Are they even options?  When should you file an application for subsidized senior housing?

Should you have long-term-care insurance?  How will you pay for hospitalizations or in-home care?  What will be the financial position for the surviving partner when one passes away?

These questions and many others are part of important discussions that should take place — now.  These conversations are difficult, emotional, and critically necessary BEFORE you get sick, BEFORE a catastrophe occurs, BEFORE decisions are required in a turbulent environment.

For same-sex couples, dealing with these issues up front is especially important.  Marriage equality is an earthquake of changes that will not be settled for some time.  And even when it is “settled” law, not all couples will choose to marry.

After beginning discussions with your partner, often a difficult task even on easy topics, start making concrete decisions.  Put those decisions in writing and make sure that they are legally binding.  Execute a will, a living will, financial and medical powers of attorney, and a disposition of remains.

Several publications and websites are available to help you plan for successful aging and end-of-life issues.  A Google search will get you to these.  To help inform your conversations about dying with dignity, contact Compassion & Choices at 800.247.7421800.247.7421.  Another resource, ProCon.org, provides information about controversial and important topics, and they have a state-by-state guide to physician-assisted suicide.

As part of your planning and decision-making process, seek the support of a geriatrician, geriatric social worker, elder-law attorney, or other professional with experience navigating end-of-life decision-making.  The EI’s Clark believes that “it is crucial that you not only express your wishes but also that you develop strong relationships with supportive others. The supportive network, which includes clinicians and loved ones, must establish and maintain an open and trusting relationship.”

Finally, if you are considering suicide because you are depressed or for a reason other than dealing with a fatal or painful and debilitating illness, please seek help from your health care provider, faith representative, or a trusted friend.  Some hotlines that you can access are: VET2VET, a veteran’s crisis hotline, at 877.838.2838877.838.2838; or National Suicide Prevention Lifeline at 800.273.8255800.273.8255 or 800.784.2433800.784.2433.  For Spanish language, call 888.628.9454888.628.9454.






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