Section 3 Exercise 7Advance directives
Clinical correlate #7: advance directives
Advance directives are obtained in order to facilitate a rational approach to death. When obtained ‘in perfect health,’ they are thought to be less fraught with emotional distractions, such as fear or guilt. At the same time, patients are encouraged to revisit their decisions over time. Read the following poem and answer the discussion questions. Of note, On the Beach, a movie to which the poet refers, is based on a book of the same title by Nevil Shute. An atomic bomb has released a dose of radiation that is lethal to humanity. The novel’s characters await inevitable death.
Linda Pastan, "An early afterlife"
Why don’t we say good-bye right now
In the fallacy of perfect health
before whatever is going to happen
happens. We could perfect our parting,
like those characters in On the Beach
who said farewell in the shadow
of the bomb as we sat watching, young and holding hands at the movies.
We could used the loving words
we otherwise might not have time to say.
We could hold each other for hours
in a quintessential dress rehearsal.
Then we could just continue
for however many years were left.
The ragged thing that are coming next—
arteries closing like rivers silting over
or rampant cells stampeding us to the exit—
would be like postscripts to our lives
and wouldn’t matter. And we could bask
in an early afterlife of ordinary days,
impervious to the inclement weather
already in our long-range forecast.
Nothing could touch us. We’d never
have to say good-bye again.
Linda Pastan An Early Afterlife Norton & Company New York, London 1995 p. 72
With permission
Study questions
- In this poem, the lovers say good-bye while they are in perfect health. What is the poet’s argument on behalf of this ‘advance directive?’
- There is a slightly facetious tone in her suggestion. What is the problem with her argument?
- What are some of the practical and psychological challenges the physician faces in obtaining advance directives from her patients? What do you think about using a poem like this as a means of facilitating the process?
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