Today I will be publishing several posts. and discussing some things to consider if you are planning on living in another country, or even just making a long-term visit. Back home in the Hudson River Valley of New York, I have two friends who are from other countries and I have seen their struggles when family members become sick overseas and the heartbreak that can result when they cannot just pick up and go – one due to age and health problems and the other due to having a young child and also having a job.
Unfortunately, right now I am also experiencing this, due to a situation which I will not go into now as it is still evolving, but will mention when the time is appropriate. This post will deal with those issues, and then I will publish two other posts on other topics.
Just as the Terry Schiavo tragedy spurred people to address certain issues before the need arose, there are certain things to address before you make a move – it doesn’t even have to be overseas; it could be just across the country in which you live.
The very first thing is to make sure you and your loved ones have a health care proxy. This is a legal document that states who is allowed to make healthcare decisions for you if you should become unable to make your own decisions – this would not only be if you are unconscious, but also confused and not competent to make any kind of judgement in your own behalf. This is different from a financial power of attorney – but that is also a good thing to have and designate someone you trust.
In the United States (U.S.A.) the details can vary state by state, and also institution by institution. For example, in the hospital in which I worked, if a patient came in with an out-of-hospital DNR (do not resuscitate), we would then have the patient or responsible party sign an in-hospital DNR. If they were brought to the hospital, it is expected that they wanted some kind of treatment, so we would need to have a signed statement regarding when they would allow such treatment to be stopped.
It is also VERY important that the person signing the proxy have a serious and lengthy discussion with the person that they are designating to make their decisions for them – do they want artificial feedings, antibiotics, IV fluids, etc. Would they prefer to be a little bit conscious even if it means they are in pain, or would they prefer to be totally unconscious and pain-free, or somewhere in between?
IF you are unsure of everything involved, discuss it with a lawyer or healthcare worker. End of life care is much more involved than people realize – it is not just a ventilator and chest compressions as shown on TV and the movies. Instead, it is also about making the person comfortable in the way that honors their beliefs and wishes.
Also keep in mind that the person you delegate might not be a relative or person in a position of power over you. Many years ago, I attended a lecture about this by a priest. He said that his bishop believed in doing everything – which sometimes only extends the dying process, not promote life. This was not the priest’s wishes, so he designated someone else to be his proxy. In the event of no proxy, the decision will go to the legal next-of-kin, who might not share your values, so you need to give this a lot of thought. And – consider this: you might be young and healthy, but situations can change in an instant, such as a car accident, so the discussion needs to be done sooner rather than later.
So – you have written your health care proxy after serious discussion with the person or people you have chosen, you have a copy to carry with you and your proxy/proxies also have a copy. You arrive at your destination and give a copy to a responsible person at that destination (for me, it is the people in charge of the office here).
Now you have the communication issue. Here, I have access to the internet, and to save on massive charges by Verizon, I have a sim card from the Mexican company Telcel, so that for 200 pesos a month (maybe $15 US, give or take) I can make all the calls I want here. The problem is when someone back home needs to call me in an emergency and so, on the suggestion of my nephew, I installed Whatsapp. Problem is, between the U.S. and Mexico, we can only text, not talk on that app, and then it does not consistently work. My problem was partly solved by having a third person, someone in the office who checks her email frequently both in the office and at home, who will see an email notifying her of an emergency, who will then call me on my cell at my Mexican number. Therefore, this had to be coordinated among the three of us.
The final component of this very serious post is to have a responsible person back home who can take charge if you have a relative who might need assistance while you are away and in the best case, is also a proxy for that person. Making judgements from thousands of miles away or in a foreign country is very difficult, and having someone “on the scene” to evaluate the situation with whom you can discuss the particulars is very practical and very comforting.
I know many of you don’t like to think unpleasant thoughts, or think you are young and healthy so you don’t need to think about things like this, but it is a necessary part of living for things to happen, as in “Life is what happens while you’re busy making plans.” And, while I haven’t read every travel site in existence, I also have not seen any discussion such as this on any of the sites I have visited. So please take a moment to consider what I have written, as it entirely comes from my experience as a human being, as a traveler and as a nurse with 45 years experience. I have seen more situations than I care to count where, unfortunately, lack of discussion and preparation have caused grief and distress to both patients and families.