A doctor's unique living will

Who says this document has to be cold and dry?

Bill—my good friend, colleague, and patient—handed me his living will shortly before he had exploratory surgery for an acute abdomen. Fortunately, I didn't have to execute his end-of-life wishes. He recovered from surgery and is again healthy.

But Bill's words—he's a pediatric cardiologist—made a lasting impression on me. His living will was not simply a dry legal document meant to satisfy a need for neat packaging, as so many are. It was personal and emotional, and it addressed the patient-physician relationship. He didn't intend for his doctors to be passive bystanders, simply carrying out his last requests. I was gratified that he wanted his physicians to be part of the decision-making process, which is how it should be. It is far too simplistic to assume we should grant the patient whatever he wants because it is his right.

Bill's living will is both whimsical and serious, and it captures the person he truly is.

—Alan Roberts, MD
Internist/Augusta, GA

Living Will and Advance Directive of William Patrick Brent*

This statement was discussed with my wife, Ann W. Brent, on the evening of 18 July 1997, in Medical College of Georgia Hospital and Clinics, room 6679.

Should I become vegetative or reach a terminal status, I wish to have all life support systems withdrawn, including maintenance fluids. My desire is to be maintained in a pain-free state, regardless of narcotic dosage and potential side effect (e.g., apnea). By terminal status, I mean that my physician has determined, as accurately as clinically possible, that I am within days of death or in an irreversible vegetative status (i.e., loss of my physical, mental, and emotional faculties). My wife may wish to participate in this process, but I do not want my children to be active decision-makers. I have observed and participated in too many situations in which the children and other relatives wanted "everything done for good old Dad."

I would prefer to expire at home with home health care, as necessary, or in hospice. I wish to be in an environment that is convenient for my wife, children, other family members, and friends to visit and say goodbye, and for my faithful canine companions, Fletcher and Molly, to be by my side.

I desire to wear my St. Francis medal, hoping that he will intercede for me, and to have my rosary in my hands. I will need all the help I can get to make the final journey. I desire to receive the last rites of my beloved Roman Catholic Church and, if possible, to have prayers said for the salvation of my eternal soul.

I would appreciate having an old-fashioned wake, so all of my family and friends can come visit and celebrate my soul being freed, hopefully to the presence of God. It will be my final commencement and recertification. This should be a joyous event, with good food and drink and eclectic music (Mozart's horn concerto, Irish jigs, Polish polkas, German oompahs, and the songs of Cat Stevens, the Mamas and the Papas, Peter, Paul, and Mary, and Judy Collins).

I would like my funeral to be at St. Mary on the Hill Church. I would enjoy having my family, friends, colleagues, and as many students and patients as possible attend and join in the singing of "Amazing Grace" and "Send in the Clowns." Readings should include the Prayer of St. Francis of Assisi, George Bernard Shaw's "A Celebration of Life," and passages from Thomas à Kempis' Imitation of Christ (you can choose the ones you think most appropriate of those I have underlined in my copy of Harold G. Gardiner's translation). Ideally, the weather will be pleasantly cool and dry.

My ego would like a big sendoff. I'd like to thank everyone for allowing me to have such a wonderful life and to contribute in some small way to theirs. I would like this occasion to bring joy to those who believe that I have gone home to the true final destination. I have always smiled when a flight attendant announced that "we are arriving at our final destination." I thought that a bit premature and presumptuous.

I desire to be cremated and have my ashes distributed (with limited environmental contamination) over Lake Erie, my parents' plot in Cleveland's Calvary Cemetery, and wherever else my wife and children think sentimentally appropriate. My wife and I both desire a memorial in Augusta, GA, which has been my home and is the place of my children's roots. In lieu of flowers, contributions should be made to the Children's Heart Program, c/o the MCG Foundation.

It has been a great journey. I have had a fantastic family whom I have loved very much. I have had great friends and mentors. All of them have been supportive in so many ways, and they are the ones responsible for any small accomplishments I have made.

I have never given enough credit to my mom and dad and grandma for all of their love, discipline, training, and sustenance. I look forward to joining them soon and expressing my love and gratitude.

I thank the Medical College of Georgia for enabling me to practice what I really enjoyed doing. Pediatric cardiology has been a wonderful medical career, allowing me to incorporate ministry and coaching into one package.

I look forward to seeing all of you in the future (even you, Maury).

Enjoy your journey.

I have loved you all to the best of my ability. I'm sure it often seemed inadequate to you, but I was trying—really.

No tears. I'm going where I have always wanted to go. This is the cruise I wanted to take. We will be together soon.

Vaya Con Dios

Shalom

William P. Brent

19 July 1997

*A pseudonym.

 

Alan Roberts. A doctor's unique living will. Medical Economics 2001;4:140.