What defines quality of life for you? It’s a moving target and very personal. An IESE Business School articles elaborates:

"Quality of life" is subjective and multidimensional, encompassing positive and negative features of life. It's a dynamic condition that responds to life events: A job loss, illness or other upheavals can change one's definition of "quality of life" rather quickly and dramatically.

Have you taken the time to think about what makes life worth living? And, if you have, have you shared your thoughts with the people close to you? They’re the ones who will have to make decisions on your behalf, if you are unable. By definition, these will be stressful times. Operating without enough information only exacerbates the stressfulness.

My mini survey

While struggling to define quality of life for myself, I quizzed several friends on the subject. (Note: this is not a random sample, nor is it statistically significant…only interesting!) I vaguely recall Ron telling me, when we were decades younger, that he wouldn’t want to live in a wheelchair. How does he feel about that now? Being able to walk is no longer a deciding factor in his quality of life. Even if he couldn’t walk, he could still read, listen to music, operate his ham radio. His definition has changed.

My dear friend Cecile is a sociologist with a professional interest in gerontology, the scientific study of old age. She has given this subject a lot of thought, done research on it, and published papers in academic journals. When I asked her what quality of life meant for her, she quickly responded “Waking up in the morning with something to look forward to.” That might mean a visit from a friend, a cuddle from her pups, working in her garden, teaching a class at the Y. The important ingredient is hope. As Anne Frank wrote “Where there’s hope, there’s life.”

Rachel’s factors were similar to Ron and Cecile’s:

• to experience nature, feel the sun and the wind on her face;

• pets to cuddle and love

• a hug

• the taste and smell of wonderful food

• the ability to communicate

• music…of her favorite genres, please (no elevator tunes!)

• access to book based on her abilities to read, whether print, audio, or braille

• companions who like to smile and laugh

I found myself nodding my head and agreeing with everything my friends shared (ok, maybe not the ham radio part). From years of observing my dad, I would add

• Being loved, continuing to have friends and family

• Making a difference

At 97, my father has lost more loved ones than many of us have even had! He treasures his children, grandchildren, great grandchildren, nieces and nephews, and his friends, old and new. His life has been devoted to others as a teacher, coach, father, husband, and friend. Dad lives to do for others. He continues to encourage and support me in all aspects of my life, professional and personal. Ron and I make an effort to point out and remind him of his ongoing positive influence on other people’s lives—family, friends, his church family. Being loved and making a contribution are essential to my father’s will to live.

Who will speak for me?

The dynamic nature of quality of life makes it all the more important that we talk about what matters most to us with our friends and family regularly. The better they understand what we care about today, the better equipped they’ll be to make decisions if we’re suddenly incapacitated. You don’t want a decision maker who doesn’t really understand your wishes!

Most of us haven’t been trained to make tough medical decisions under trying circumstances. We’re likely to:

• Question the patient’s stated wishes, uncertain the person had this specific situation in mind. If there are multiple family members with different views, this is even more likely. This lack of confidence can lead to making choices that aren’t consistent with the person’s stated preferences. My friend Gwen told me the story of her good friend who had a massive heart attack. Even though she had a do not resuscitate order in place and did not want extraordinary measures taken, in this moment of stress, her son agreed to have her resuscitated and airlifted to the hospital. Gwen was thankful that her friend died en route to the hospital and was spared further “treatment”.

• Mistakenly substituting our own wishes for the patient’s. We tend to do this subconsciously, without realizing that our own preferences aren’t identical to those of the person for whom we’re deciding. In caring for my parents over the years, I have had to frequently remind myself not to impose my wishes on them. I felt for years that they needed help managing their medications—there were many, with lots of different requirements on when, how and how often they were taken…and I saw my folks make obvious mistakes during my visits. However, they were still cognitively able to choose. And their choice was to take the risk of taking their medications incorrectly and maintain complete independence.

Your local hospice can help you and your designee understand what kinds of decisions may need to be made. Preparation through education and dialog is the best route.

Thinking about what is most important to you, sharing that information with those close to you, learning more about situations that you may face are all important steps. But unless you’ve executed advanced directives, your chosen advocate won’t have the legal ability to stand in for you. When it comes to preserving your quality of life, both healthcare and financial decisions play major roles. You need to a healthcare power of attorney to name someone to make medical decisions. With a durable power of attorney, you’ll appoint a representative to make financial decisions. These are documents an estate or eldercare attorney can help you put in place, or contact your local hospice for education and referrals. If, like me, you’re eligible for membership in the North Carolina State Employees Credit Union, check out their very affordable estate planning service utilizing attorneys in your area. And while you’re preparing these documents, make sure to name at least one alternate, in case your designee is unavailable or unwilling to act on your behalf at a critical moment. I know, I’m the only person on the face of the earth who gets charged up about estate planning documents…but you need these! You can thank me later.

This should scare you

I hate to close on a somber note…but do you want a random ER doctor or hospitalist making life decisions for you? If you’re very cynical, you believe they’ll be making decisions based on what will squeeze the most money out of your insurance company. If you’re not, you’ll expect them to do what they are trained to do—preserve any type of life at virtually any cost. Keeping you alive and “safe” will be top priority, even if that equates to spending your remaining days lying in a hospital or nursing home bed. Take steps today to talk with your loved ones about what matters most to you and get your legal documentation in order!

I’m passionate about living my best life. I want to help my friends, family, and clients identify and find ways to live theirs! Please share your thoughts with me at beth@fairwindsadvice.com. For assistance in planning for your best life, give me a call at (336) 701-2612.

Investment advisor representative of and investment advisory services offered through Garrett Investment Advisors, LLC, a fee-only SEC registered investment advisor. Tel: (910) FEE-ONLY. Fair Winds Financial Advice may offer investment advisory services in the State of North Carolina and in other jurisdictions where exempted.