Corinna, a widow for over twenty years, was used to making decisions for herself. In her mid-80s, her mind was clear and she managed her affairs well. She had a will in place ever since her husband died, she had all her financial and legal documents in meticulous order, and she had purchased long-term care insurance. She knew that to complete her planning, she also should appoint a health care agent. Her daughter, Barbara, was the natural choice. An only child who never married, Barbara was a smart, successful businessperson and they were very close. They lived a few houses away from each other and spoke every day. They helped each other with chores and shared all the important aspects of each other’s lives. Yet, Corinna hesitated to appoint Barbara as her health care agent.

Corinna felt happy with the long and rich life she had had, and she wanted it to continue. But, if her quality of life were severely compromised, she would want to die naturally and not prolong her life with artificial devices to help her breath or eat. She remembered her older sister. Sylvia had had a massive stroke and lost her capacity to communicate her wishes. When she was not able to swallow, her doctors asked Sylvia’s husband about giving her a feeding tube. He had asked if it would keep her alive longer and, when the doctors said it would, he asked that the tube be inserted. Sylvia lived for almost five years after that with a quality of life that Corinna did not want for herself. And she was pretty sure that Sylvia would not have wanted it either and that her husband knew that but could not bring himself to making a decision that would let her go.

Corinna was not sure if Barbara would be able to follow Corinna’s directives to allow a natural death. Regardless, she did not want to put her dear daughter in the uncomfortable position of having to tell doctors that she did not want a procedure done that could prolong her mother’s life. It would be a difficult thing to say.

Marlo, half way between the two women in age, was a good friend of Corinna’s and knew Barbara well. She was level headed and had been a health care agent for a cousin and a sister who both died in the hospital. She would not be afraid to discuss outcomes with the doctors and would respect Corinna’s wishes. Corinna called her and sat down to discuss her choices with Marlo. Corinna explained why she wanted Marlo and not Barbara to be her health care agent. Marlo accepted the role, but only after Corinna agreed to call Barbara so that the three of them could discuss Corinna’s wishes together. Barbara must understand that if any difficult choices had to be made, the decisions were Corinna’s. Marlo was only acting as the spokesperson for Corinna. Barbara was relieved to know that she would never have to voice these difficult decisions for her mother and Corinna felt secure that her wishes would be followed.

Together, the three of them thought of another friend who was also brought into the conversation and was appointed the alternate agent.