We all have two great end–of–life fears:

• Being forced to live for months to years after reaching Advanced Dementia, if we have severe enough suffering of various causes, to want to be allowed to die of our underlying disease (especially if our suffering may be untreatable, or unrecognized and under-treated); and,
• Enduring days to weeks of unending, unbearable physical or emotional pain and suffering before you die.

To avoid prolonged dying with suffering, your future physicians must honor your expressed Known Wishes. Completing Steps 1 through 5 of Strategic Advance Care Planning represents your best effort to be clear, consistent, comprehensive convincing, and compelling. But the best documents and recorded videos must be readily accessible to your future physicians and emergency medical personnel when “that time” comes. This is the goal of Step 6, MyLastWishes.org. It is a registry that strives to provide ready access to all your advance directive forms and videos

Note: Some people do not need such a registry. The medical charts of patients who reside in skilled nursing facilities, for example, may be nearby (down the hall). If your needs are less than what MyLastWishes.org offers, you can find a national registry that costs less. If you desire more personal attention, you may be interested in the program of the Institute on HealthCare Directives called MIDEO (at InstituteHCD.com). Dr. Ferdinando Mirarchi leads this program and he is the recognized expert on implementing protocols to accurately communicate patients’ wishes in medical emergencies.

The My Last Wishes.org Program provides treating physicians and others with:

• A short video of your current treatment preferences in case of an emergency (CPR versus DNR versus CPR + Natural Dying)—along with a printed copy of your Physicians/Providers Orders for Life-Sustaining Treatment form and optional Medallion;
• Readable displays of all your completed forms (POLST, Living Will, Strategies, etc.);
• Ability to print, download, email and fax any document to clinicians;
• Beyond emergencies, access to your long recorded videos of the interview where you stated for which conditions you want Natural Dying (those you judged would cause “severe enough suffering”).

MyLastWishes.org provides you with cards that have a 2–dimensional bar code, extra labels to place on key forms such as insurance cards and driver’s licenses, an optional metal medallion/dog tag that you can wear, and a pouch to wear your Physicians/Providers Orders for Life–Sustaining Treatment (POLST form). As shown in the demonstration below, others can access your forms and videos by entering your full name and birthday on their computer. (Note: Minimizing the required identifying information is the way to maximize accessibility, which you may want in an emergency.) MyLastWishes.org recommends a combination of the POLST form and a medallion because a piece of paper may be hard to locate quickly in emergencies while a medallion—by itself—may be too small to provide enough information beyond “DNR or CPR.”

The MyLastWishes.org Program can offer solutions in the following six areas:

[1] If you are CPR/Full Treatment but have a chronic life–threatening illness and want to increase your chance of survival, the MyLastWishes.org Program is designed to quickly inform emergency medical personnel and physicians about your medical diagnoses and medications so they may be able to more quickly find and treat the likely cause of, for example, your sudden unconsciousness.

[2] In addition to the DNR order, you may need the order, “Do NOT start an I.V.” (Intra–Venous hydration)—if it is time for Natural Dying. Otherwise, extra fluid can prolong your dying. (Emergency medical personnel are trained to start I.V.’s almost “automatically.”)

[3] Middle Stage Dementia patients risk wandering and getting lost. This could cause harm, and be life–threatening. People who find the lost patient must quickly learn the patient’s identity, the family members’ address and contact information, and the physician’s contact information.

[4] Suppose the time comes for your Natural Dying, but there is a conflict. Your proxy/agent can play your previously recorded long video on which you expressed WHAT you want WHEN and explained WHY. If someone questions if you had capacity, part of your recorded video is the opinion of the health care professional who interviewed you. Your video may convince others to HONOR your wishes promptly, without a prolonged conflict.

[5] Future physicians can also retrieve such forms on which you gave your informed consent forms for Palliative Sedation to Unconsciousness—get total relief from otherwise unbearable end—of–life pain and suffering.

[6] You may also submit other personal documents for other to view later, such as who you want to visit you, and your “Ethical Will,” where you can list the values in life that you found important and hope others will follow.

NOTE: The MyLastWishes.org program is available only to people who have completed Steps1 through 5 of Strategic Advance Care Planning.

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