The title of today’s post comes from one of my favorite characters in the movie, “The Untouchables”. In the film, Sean Connery’s beat cop character Malone cajoles Kevin Costner’s Eliot Ness into deciding how far he is willing to go to “get Capone”. You can see the first time he’s asked this, Ness hesitates and carefully considers his response, which is to do whatever is within the law. We, the viewers, know what it will take to bring Capone down and it’s somewhat painful to watch Ness’ slow process to get there. The final time Malone asks Ness “what are you prepared to do”, he’s speaking with his dying breath, bloodied on his living room floor. Ness, now motivated by avenging his friend’s death, is prepared to do whatever it takes within or outside the law.
In advance care planning, “What are you prepared to do” is an important question for each of us to ask:
- of ourselves in making choices about the healthcare we will receive and when comfort should prevail over cure,
- in defining our own quality of life, and,
- of our loved ones whom we expect (yes, expect) to make decisions for us if we are not able.
That last bullet point is very important. So often I have heard people say that their spouse and/or their children “know what I want” or they will “know what to do”. But when I delve deeper with more probing questions, I learn that expectations are held that spouses and/or children are not prepared to fulfill or of which they are not even aware.
There is a natural instinct to name the person(s) closest to us as our substitute decision maker(s). We choose someone we love and who loves us; someone who knows us as well as they know themselves. But we often do not have the detailed conversations that will prepare them for the actual act of making decisions for us. It is very clear from literature reviews and conversations that most of us do not want to be a “burden” for our loved ones. We tend to decide for them what would be burdensome. Without talking to those we love, we convince ourselves that making decisions about our healthcare, or placing us in a nursing facility, or opting for hospice care will be handled willingly when the time comes. We have expectations that we will be cared for in a manner consistent with our values and beliefs and definitions of quality.
So, as important as it is to choose someone to be our substitute decision maker when (not if) we are unable to speak for ourselves, it is equally important to ask that person(s): “What are you prepared to do …. for me?”
(c) 2013 Caring Choices