Why not? is the thought that popped into my head as I read a LinkedIn description of someone being called to her husband’s bedside after he had had a catastrophic brain heamorrage.

I don’t mean this callously, but I am curious. What do we imagine when we promise ourselves for better or worse, in sickness or in health, until death do us part? Even as we articulate them, the words ‘worse’ and ‘death’ seem to vacate themselves of meaning. We don’t imagine anything at all; we’re caught up in the frisson of romance and the idea of the life that we’re going to share and the children who will be born or the adventures that we will embark on together. Unless, of course, we’re getting married in later life as many of us are now, when ‘worse’ and ‘death’ have more space at the table.

I feel a bit like the thirteenth fairy at Sleeping Beauty’s Christening bringing this up, but shouldn’t we be talking about the worse and the death bits? Full disclosure, I’ve made these vows, or modern derivatives of them, twice over. I’m not advocating for any outdated moral imperative of being bound to the ‘worse’ aka domestic abuse or anything like that. What I mean is how, when the love and committment are still there, do we anticipate navigating the ‘worse’ and the ‘death’ aspects of long-term partnerships? As a non-negotiable part of the human condition, suffering is necessarily going to show up as an unwelcome guest to the marriage.

What can we do that would gently prepare us?

With what resources can we gird ourselves so when ‘worse’ appears we have the skills to navigate it?

Making a living will seems to me to be the most significant action we can take to prepare ourselves because it makes us pin down what we would like to happen in certain, as yet unforeseen, circumstances. To write a living will or advance directive, demands that we educate ourselves about the decisions that we, or our representative, might be called upon to make. Once educated, we must then work out how we want to orientate ourselves to the answers. I phrase this carefully because we can not anticipate all scenarios and decide how we would act in all possible eventualities. Rather, it is by determining our death values that we establish a framework in which we make the decisions required in the event of ‘worse’.

The wife of the man with the brain haemorrage was having to build the framework in the adrenalin fuelled drive to the hospital. These are not ideal circumstances for making profound life and death decisions. If, by contrast, they had discussed at length what was meaningful to them in extreme circumstances, her drive to the hospital would still have been awful, but she would have had a little bit of comfort knowing that she already understood what was important for her husband and what type of answer she might need to give to the doctor’s questions.

It might not sound like much comfort given how devastating her husband’s prognosis was and how suddenly it had happened, but imagine having to make a treatment decision without any idea what your spouse might have decided for themselves. After coming to a decision about what to put in a Living Will, sharing it with those who might have to make the decisions for us is the next step in resourcing ourselves for the worst times.

My daughters know that less rather more is my preference when it comes to end of life medical interventions. They also know that if they are persuaded to agree to a treatment that leaves me in a persistent vegetative state, my worst case scenario, that’s still ok. I’m good with death, and whatever suffering is its preamble, I’ll still be ok because I know that they will have done everything in their power to make the right decision even if the outcome is dreadful. I trust life on some deep level. They don’t need to shoulder any guilt.

This is a beautiful gift we give those to whom we are making a “for better or for worse” promise. In the event of the ‘worse,’ their grief doesn’t have to be overshadowed by guilt that they made the wrong decision. We are also more likely to receive care that is in keeping with our values and our partners will understand why we are making the decisions that we are. My daughters won’t think I’m rejecting them and the life I’ve got with them if I decide against treamtment, should the occassion ever arise, because they already know what I think about these matters.

Of course, ‘worse’ comes to us whether we’re in a promised relationship or not so we still need to consider the brain haemorrhage scenario. Who would you like to be the one speaking on your behalf while you’re unable to? It’s not enough just to appoint a Power of Attorney, they also need to know our wishes so, once we’ve educated ourselves about dying and got clear about our death values, we must have a frank conversation with those who will be shouldering the legal decision making role.

If you would like to learn more about making a Living Will, Powers of Attorney and working out what your death values are, join me for Death Values 101, a 2-hour workshop designed to help you gird yourself and those you love for the ‘worse’ and freeing you to live the ‘better’ in all its fullness.