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The Self-Made Man

Premiere Date: July 26, 2005

Survey: Your End of Life Decisions

These questions are designed to provoke deeper thought about what makes life worth living and, conversely, when and if we can reach a point where life is no longer worth living. Today these issues are on many Americans' minds. Increasingly, we recognize dying as an important part of life. And over the past decades, the "American way of death" has come to involve, more and more, the idea of choice. When we face choices about the end of life, the difficulty often lies in balancing many competing considerations, including our personal beliefs about dying, our care options, and our desire to protect our families. We invite you to take a closer look at your own personal values and priorities.

Download a PDF version of this worksheet »

Would you agree or disagree with the following statements?

   AGREE       DISAGREE   
Aging has a special value.
Dying is an important part of life.
The length of my life is important, but so is the quality of my life. There are circumstances under which I would not want my life to prolonged.
I want to live as long as possible. My physical comfort, chances of recovery or expense should not be a consideration.
I believe that it is always wrong to withhold or withdraw treatments that could keep me alive.
My family should comply entirely with my personal wishes.
My wishes are not as important as what my family decides is best. They should consider their own emotional and financial interests along with my well-being.

The meanings of "quality of life" and "a good death" are deeply personal. Rank the following in importance to you:

QUALITY OF LIFE
Not important
Somewhat important
Highly important
Getting out of bed every day
Spending time outside
Providing my own care
Being aware of my surroundings
Recognizing my family, friends and loved ones
Being able to communicate with my family, friends and loved ones
Remaining in my home as long as I live
Leaving my loved ones with good memories
Leaving money to my family, friends or a charity
Fulfilling personal goals

DECISIONS
Not important
Somewhat important
Highly important
Honest answers from your doctor
Making decisions for myself
Receiving all possible medical treatment
Living without pain
Consulting a religious advisor to ensure that decisions are made in
keeping with my religious tradition
Not being a burden on my loved ones
The opportunity to plan my own funeral
The opportunity to complete my will

MANNER OF DEATH
Not important
Somewhat important
Highly important
Avoiding pain and suffering, even if it might hasten death
Being alert, even if it means I might be in pain
Dying naturally
Dying without lingering
Being with my loved ones at the time of death
Having time for a special ritual gathering such as a prayer service,
readings or sharing memories with loved ones
Having religious or spiritual advisors at my side


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