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で観ることもできます。【要約】
１．よい人生の終わり方（死に方）の話
ヒトはよい人生の生き方を考えるが、終わり方（死に方）についてはあまり考えない。私がジムとシャーリーの人生の終わり方をお手伝いした経験をお話しする。
２．人生の終わりに向かう日々
やり残したことを終わらせる時期 受けとめる時期 迎える時期
３．実践すべき五つのこと（Good End Of Life Worksheets）
①計画をつくる
身体がいうことをきかなくなったとき、どこに居たいか、どこまで医療行為を求めるか、誰に計画を実行してほしいか
②後見人を雇う
自分の意思を代理してくれる人が必要だ。配偶者や子供に限らず、プレッシャーに強い人を雇うべき。
③病院に対する準備をする
緊急搬送に備えて、病院に何を望むかをはっきりと意思表示した紙、保険証、委任状を用意して、代理人と自分が持っておく。
④場所と介護者を選ぶ
最後を迎える場所と介護者を選ぶ。妥協してはいけない。
⑤最後に言って欲しい言葉を考える
最後の最後に、誰から、どんな言葉を言って欲しいかを知らせておく。
４．最後まで人生の質を保つために
死について考えることは恐い。しかし、しっかりと準備しておけば、最後まで人生の質を保つことができる。
geriatrician ：老年病専門医
preschoolers ：未就学児
qualitative ：定性的な
only child ：一人っ子
trustee ：管財人
medical advocate ：医療擁護者
fractures ：骨折
neurological illness ：神経疾患
ACR ：Audubon Canyon Ranch
ranch ：大牧場
diagnosis ：診断
intuition ：直感
reassurance ：安心
medical intervention ：医療的介入
proximity ：近接、そばにいる
ever-changing ：絶え間なく変わる
critical ：重大な
do-not-resuscitate order ：蘇生禁止指示書
caregiver ：介護士
【transcripts】
What would be a good end of life? And I'm talking about the very end. I'm talking about dying.
We all think a lot about how to live well. I'd like to talk about increasing our chances of dying well. I'm not a geriatrician. I design reading programs for preschoolers. What I know about this topic comes from a qualitative study with a sample size of two. In the last few years, I helped two friends have the end of life they wanted. Jim and Shirley Modini spent their 68 years of marriage living off the grid on their 1,700-acre ranch in the mountains of Sonoma County. They kept just enough livestock to make ends meet so that the majority of their ranch would remain a refuge for the bears and lions and so many other things that lived there. This was their dream.
I met Jim and Shirley in their 80s. They were both only children who chose not to have kids. As we became friends, I became their trustee and their medical advocate, but more importantly, I became the person who managed their end-of-life experiences. And we learned a few things about how to have a good end.
In their final years, Jim and Shirley faced cancers, fractures, infections, neurological illness. It's true. At the end, our bodily functions and independence are declining to zero. What we found is that, with a plan and the right people, quality of life can remain high. The beginning of the end is triggered by a mortality awareness event, and during this time, Jim and Shirley chose ACR nature preserves to take their ranch over when they were gone. This gave them the peace of mind to move forward. It might be a diagnosis. It might be your intuition. But one day, you're going to say, "This thing is going to get me." Jim and Shirley spent this time letting friends know that their end was near and that they were okay with that.
Dying from cancer and dying from neurological illness are different. In both cases, last days are about quiet reassurance. Jim died first. He was conscious until the very end, but on his last day he couldn't talk. Through his eyes, we knew when he needed to hear again, "It is all set, Jim. We're going to take care of Shirley right here at the ranch, and ACR's going to take care of your wildlife forever."
From this experience I'm going to share five practices. I've put worksheets online, so if you'd like, you can plan your own end.
It starts with a plan. Most people say, "I'd like to die at home." Eighty percent of Americans die in a hospital or a nursing home. Saying we'd like to die at home is not a plan. A lot of people say, "If I get like that, just shoot me." This is not a plan either; this is illegal. (Laughter) A plan involves answering straightforward questions about the end you want. Where do you want to be when you're no longer independent? What do you want in terms of medical intervention? And who's going to make sure your plan is followed?
You will need advocates. Having more than one increases your chance of getting the end you want. Don't assume the natural choice is your spouse or child. You want someone who has the time and proximity to do this job well, and you want someone who can work with people under the pressure of an ever-changing situation.
Hospital readiness is critical. You are likely to be headed to the emergency room, and you want to get this right. Prepare a one-page summary of your medical history, medications and physician information. Put this in a really bright envelope with copies of your insurance cards, your power of attorney, and your do-not-resuscitate order. Have advocates keep a set in their car. Tape a set to your refrigerator. When you show up in the E.R. with this packet, your admission is streamlined in a material way.
You're going to need caregivers. You'll need to assess your personality and financial situation to determine whether an elder care community or staying at home is your best choice. In either case, do not settle. We went through a number of not-quite-right caregivers before we found the perfect team led by Marsha, who won't let you win at bingo just because you're dying but will go out and take videos of your ranch for you when you can't get out there, and Caitlin, who won't let you skip your morning exercises but knows when you need to hear that your wife is in good hands.
Finally, last words. What do you want to hear at the very end, and from whom would you like to hear it? In my experience, you'll want to hear that whatever you're worried about is going to be fine. When you believe it's okay to let go, you will.
So, this is a topic that normally inspires fear and denial. What I've learned is if we put some time into planning our end of life, we have the best chance of maintaining our quality of life. Here are Jim and Shirley just after deciding who would take care of their ranch. Here's Jim just a few weeks before he died, celebrating a birthday he didn't expect to see. And here's Shirley just a few days before she died being read an article in that day's paper about the significance of the wildlife refuge at the Modini ranch.
Jim and Shirley had a good end of life, and by sharing their story with you, I hope to increase our chances of doing the same.
Thank you.