Psychologically Speaking: Until death do us part

Psychologically Speaking: Until death do us part
DR. BATYA L. LUDMAN , THE JERUSALEM POST Dec. 6, 2007

Q.
Dear Dr. Batya,
I recently was told that Israel is desperately in need of transplant donors. I'm interested in donating various parts of my body when I die, but whenever I try and raise my ultimate passing with my children, they say, "God forbid, Dad; let's not even think about it." As a result, I have not been able to tell them how I feel nor know how to broach this topic.
- G.B., Netanya

A.
First of all, I'd like to say being an organ donor is one of the greatest gifts that you could give to someone else. You are quite right about Israel's need for donors. Approximately 800 people are waiting for an organ transplant or replacement. Of these, half are waiting for a kidney or cornea and may die while waiting for a suitable donor to be found.

Why do I mention these two specifically? Many people are afraid of organ donation because they erroneously think it is prohibited by Jewish law. This couldn't be further from the truth. Although according to most rabbis there is absolutely no problem at all in donating even organs such as the heart or liver, one can wait up to as much as 40 minutes after death to transplant a kidney or a cornea. Thus, even if a decision to offer an organ for transplant was not made ahead of time, this should still enable the family to make an informed decision about donating.

I mention the family because while you can certainly sign a donor card at any time, your children will ultimately be the ones making the choice as to whether they will follow your wishes. That said, as you have said, you have to be able to make your wishes known.

Many children, regardless of age, as well as adults don't like to discuss death. Some feel that talking about death brings out the evil eye and may actually hasten it. Even those who are not generally superstitious feel that discussion might bring on problems. While I like to think that the educated and informed individual can best plan and prepare for what will be an eventuality for us all, for many it is frightening and upsetting. While not rational, as long as people are encouraged to avoid discussion of death instead of developing a sense of comfort in the topic, this unfounded fear will remain.

Talking to your children about your wishes and desires is very important for several reasons, not the least of which is helping them to be better prepared to face the future - with respect to your death or theirs. In addition to helping your children, having a discussion about death and organ donation allows you the opportunity to clear up misconceptions as well as to provide closure. Allowing one peace of mind as he thinks through his end-of-life decisions is a treasured gift that one can give to another. It shows deep respect and caring and the ability, in spite of one's discomfort, to go the extra mile for someone else.

While it's preferable to discuss one's wishes before one becomes ill, this is not always possible. Families can ask and listen to someone's wishes and provide a sense of comfort and peace of mind in hoping to be able to honor them. How, for example, would they like their death to be? Does one want to die at home or in hospital, with or without heroic actions, extraordinary measures or no intervention? Does your loved one believe in organ donation and what would he like done - all organs, specific ones or something else? What kind of burial would you want and if you could be at your funeral how would you orchestrate it? How can you best honor your loved ones? Can you talk to your loved ones and if not, can someone else? These are all broader issues but may enable you to more easily bring up being a donor in this context.

Perhaps as the adult you can begin to pave the way by opening the door during a quiet moment by enabling your children to talk. Here are a few ideas as to how you might go about it:

1. Attempt to be as open and honest as you can with your spouse, child or other family members and even close friend as to what you would like to happen "should" something eventually happen to you. This discussion can be about organ donation, funeral services, memorial donations, etc. By choosing to discuss your wishes, you can also hear what they would like.

2. Let those you care about know just how important these discussions are. Let them know that as uncomfortable as you may be in having this discussion, you are choosing to have it because it is so very important to you to have your wishes honored. Let them know how you might feel if the situation were reversed and they or you were to be offered an organ to save your or their life and thus how strongly you feel about donating an organ. They need to know that they will most likely make the ultimate decision when the time comes and that this is something that they are doing for you as well as someone else in his time of need. Hopefully knowing that your death was not in vain will provide them with some comfort at a difficult time.

3. Be prepared to hear what their concerns are. You may be surprised to discover that these may not be at all what you'd expect them to be. Remember, death is not a neutral concept. It evokes many feelings and responses. Coming to terms with the dying process can be traumatic as it brings up so many issues - many of which are uncomfortable to discuss as no one likes to think of a time when his loved one won't be around. How one views death will clearly impact on how one chooses to live his life. This will inevitably help determine how one deals with the death of a loved one.

4. Let your family know that you are prepared to discuss things in advance with a physician, rabbi, psychologist or anyone else who could possibly help make the discussion more meaningful and easier.

5. Discuss with your children the concept of a living will and make sure that you put things in writing. Let people know where this document will be located. This may be a good spot for your organ donor card as well, but you should know that these things are often not looked at until days or weeks after an actual death. Hence, you may want to tell your family that you are having this discussion with them precisely now because you want to prevent any confusion later.

6. Finally, if your loved ones simply refuse to have this important discussion, you may have to put your intentions in writing and have them documented legally. This document can then be held by someone you trust to pass this information along at the right time.

There are so many issues one must deal with when thinking of death within the context of one's family. Once the conversation has begun, you may be pleasantly surprised by what gets discussed.

The writer is a licensed clinical psychologist in private practice in Ra'anana.
ludman@netvision.net.il

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