A High Holy Day reflection on end-of-life wishes

August 2021
Harvey Starkman

If I were a Buddhist, I might be better prepared to look objectively and accept the unavoidable realities of aging, illness, death, and separation from loved ones. But I’m not a Buddhist. I have a lot trouble accepting these realities, and I know I’m not alone in this.

The COVID pandemic has made us all more aware of our mortality, and has prompted some of us to look seriously at medical crises and end-of-life planning. 

In general, we have control when it comes to receiving medical care and treatment. But what if at the end of our life, or in a medical crisis, we are not physically or mentally capable of directing our care or expressing our wishes? How will they be carried out? Who will know what we want? 

My wife and I began to ask ourselves these questions when we were invited by our machatunim— our co-in-laws — to join them in a guided Advanced Care Planning program designed by Dying With Dignity Canada.

In preparing an Advanced Care Directive, we are asked to imagine the actual end of our lives. That’s hard. We know that we are going to die, but we act as if we’re not. Denial is what gets us through. Otherwise, how could we carry on our day-to-day living?  

The end goal of the Advance Care planning process is to clearly express our end-of-life wishes in writing and to appoint a Substitute Decision-Maker — someone who will speak for us when we cannot. The journey to get to that point teaches us much about ourselves and what we truly value. It is not coincidence that I’m writing this before the High Holy Days. Focusing on how we have lived, and on how we wish to die, both demand honest and serious reflection.

I’ll admit that I like to be in control. I would rather do all the driving on a long road trip than surrender the wheel to someone else. I wish I knew how to fly a passenger jet. Developing a plan for the end of life might seem like a natural fit. But I know we can’t control everything, nor should we. 

There’s a dilemma I can’t ignore: while our focus in Advanced Care planning is on ourselves, living and dying are not just about us. And they never have been. Notwithstanding my need for control, I value the needs and feelings of others. I value peace and harmony. My wishes for my end of life might work well for me, but how will they impact my loved ones? 

There are difficult decisions to make, and as always, our choices have consequences. For example, since we can choose our Substitute Decision-Maker, who should it be? Our spouse? Our children? Will they be able to execute our wishes in light of their own needs, beliefs, and values at what is also a crisis point in their lives? What if one person is better suited than the others? What would be the immediate and long-term effects of choosing one over another, or of going outside the family to ensure that our wishes are respected? 

Did you have ‘The Big Talk’ with your children as they approached puberty? I have to admit I never did. My sons are now in their forties with children of their own, so clearly they managed without it. Now, according to the Advanced Care Planning guide, it’s time for another Big Talk, the one where we put everything out there: our wishes, our requests, our direct questions to them about their readiness and willingness to speak forcefully for us if we cannot. I’m having problems starting this talk as well. 

Reaching out to others to talk about death is hard. So is asking someone if they are ready and able to be our voice. But this is a talk we do need to have, and better sooner, when there is no immediate need, than later.

I’m coming to understand that my signed and dated Advance Care Directive is not my final statement of my end-of-life wishes. It’s more like a work-in-progress, a draft that I can revise as often as I want as my self awareness grows or as circumstances change. I find that reassuring. Meanwhile, I now have something in place that speaks to what I would ask for today, and I find that comforting. Maybe now I’m ready for that second Big Talk.

Like the spiritual work we begin over the High Holy Days, acknowledging our mortality and planning for our end of life isn’t easy. Rationally, we know that we should, though we also recognize that there’s more at play here than reason. The process may take us to places we fear to go. But so does the Yom Kippur liturgy. Hopefully, when we have done our work, we’ll have the same sense of peace we feel when the Shofar sounds and the High Holy Days draw to a close.

Harvey Starkman was born and lives 75 km east of the city, but has deep and enduring family roots in Hamilton’s Jewish community.  He is a regular contributor to the HJN.