I was talking with an estate planner today. He said that he had been trained–from a legal point of view–how to write living wills and powers of attorney for people making end-of-life plans. But he didn’t really understand the issues from a medical or caregiving perspective. He had no idea if or to what extent they had ever been used.

I told the estate planner that the end-of-life plans he writes are extremely important, but not because anyone will ever use them. Its the exercise of thinking through these issues that is important. And being able to tell other people your desires is important. But there’s really no way to know in advance what kind of end-of-life plan you will actually need. Every disease and every person is different.

Here’s proof positive of that from yesterday’s New York Times. Katherine Russell Rich writes that she has stage 4 (of four) breast cancer,

something I’ve had for 17 years. The average life expectancy with the diagnosis is 30 months, so this is a little like saying I’m 172 years old: seemingly impossible. But it’s not. I first found I had the illness in 1988, and it was rediagnosed as Stage 4 in 1993. That’s 22 years all together.

She is a member of the two percent of people with stage 4 breast cancer who have survived for so long. “Doctors can’t predict who will fall into this category. They can’t say you’re in it till you’re in it — till you’ve racked up the necessary miles.” Yet no one understands why this small group survives. Strangely, no one is researching the subject.

Yet, living with a noose around your neck provides Ms. Rich with some valuable perspective. “Life itself isn’t sensible, I say. No one can say with ultimate authority what will happen — with cancer, with a job that appears shaky, with all reversed fortunes — so you may as well seize all glimmers that appear.”

As the Apostle James wrote, “Now listen, you who say, ‘Today or tomorrow we will go to this or that city, spend a year there, carry on business and make money.’ Why, you do not even know what will happen tomorrow. What is your life? You are a mist that appears for a little while and then vanishes. Instead, you ought to say, ‘If it is the Lord’s will, we will live and do this or that.’ “


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