When I Should Die

I recently heard a report about the difficulties faced by folks who care for people who are in a persistent vegetative state. I hadn't given much thought to do-not-resuscitate orders or other advance directives. But now I have thought about it a bit, and I can offer my guidance for folks who may have to help decide what sort of medical care I receive.

My value to society and, more specifically, to my family and friends is based primarily upon what I can do. When I was young this more often involved what I could with things, recently it is what I can do with knowledge and ideas that is more important.

So here is a simple rule: when I can no longer tell you a story or laugh at your jokes my value in this world has dwindled to nothing. If there is reasonable hope that I can still communicate effectively then my desire is to keep living, even if it means I must use adaptive devices or learn new ways to communicate. Reasonable hope, to me, indicates not more than three to six months in a vegetative state. Other factors that I expect to be weighed in the decision include the costs (including financial, emotional, time, and physical effort) associated with my continuing medical care, and whether I am experiencing pain while I linger in such a state.

The above paragraph should also provide some guidance about rescuscitation efforts. I hope to continue living as long as I have some capacity to communicate with others in non-trivial ways. Therefore, if it is possible to revive me after heart failure or other catastophic event I would hope that such efforts are made on my behalf.

We are emotional and sentimental beings. I recognize that my family may wish to keep me alive even beyond the time that I can provide any useful interaction or companionship. Please, if there is no hope of recovery, allow me to pass into eternity. When all that is left of me is in your memories, that is when I should die.

James Card - January 10, 2004