Aging With Dignity: Paul Malley
Aging Gratefully
Dr. Peter Brill

Episode 19 - Aging With Dignity: Paul Malley

Something is terribly wrong: The majority of Americans want to die at home surrounded by family and friends, but most end up dying in the hospital or nursing home, cared for by strangers.  Half of Americans die in pain that could have been treated.  Sick people have come to fear losing their dignity or burdening their families more than they fear death.  And this is all happening in a country that is meant to prize the rights of individuals and champion respect for personal wishes. What can be done?

Paul Malley is President of Aging with Dignity, a national non-profit organization based in Tallahassee, Florida. More than eight million Americans have used Aging with Dignity’s “Five Wishes” document to plan in advance of a serious illness. Today “Five Wishes” is distributed by 10,000 organizations – including physicians, attorneys, hospitals, hospices, employers, and places of worship. Paul Malley and the work of Aging with Dignity have been featured in national media including the CBS, NBC, and ABC evening news, CNN, MSNBC, NBC Today Show, Good Morning America, USA Today, The Wall Street Journal, The New York Times,Newsweek, Time and Consumer Reports.

The Five Wishes document helps you express how you want to be treated if you are seriously ill and unable to speak for yourself.  It is unique among all other living will and health agent forms because it looks to all of a person's needs: medical, personal, emotional and spiritual.  Five Wishes also encourages discussing your wishes with your family and physician.

Five Wishes lets your family and doctors know:

  • Which person you want to make health care decisions for you when you can't make them.
  • . The kind of medical treatment you want or don't want.
  •   How comfortable you want to be.
  •   How you want people to treat you.
  •   What you want your loved ones to know.



Peter Brill: Well Hello, and welcome to the third age with the doctor and the man from Hollywood. The doctor is me Dr. Peter Brill and the man from Hollywood is David Debin. On this show we turn the myths of aging upside down we sort out the scientific and the trendy the medical and the cultural and we tell you everything you need to know about living in the third age. Remember we guarantee if you listen to us you will never grow old.

Marisa Scovosy: And I'm Marisa Scovosy and I'm sitting in for David Debin the man from Hollywood who is apparently on vacation. And the third age usually starts somewhere around age 45 or 50. It's a time when you start to feel a strong desire for deeper meaning and fulfillment in your life. Your fist age is childhood. Your second age is building career and family and the third age is a major change or transition to a whole new set of problems, values, opportunities and gratifications. So, join us as fellow explorers in this journey to discover what brings passion, purpose, and joy into this uncharted time of life. And the support for our program is growing. These are the people who believe in our mission.

Peter Brill: Well something is uhh is terribly wrong. The majority of Americans want to die at home surrounded by their families and friends. But most end up dying in a hospital or nursing home cared for by strangers. Half of Americans die in pain that could be treated. Sick people come to fear losing their dignity or burdening their families more than they fear death. And this is happening in the country that is meant to prize the right to individuals and champion the respect for personal wishes. What can be done? Well today's guest Paul Malley, President of Aging with Dignity is doing something about it. And so can you. Marissa, you scheduled this show.

Marisa Scovosy: I did.

Peter Brill: Why did you schedule this show?

Marisa Scovosy: I thought it was an interesting thing that we should talk about because usually I think personally its hard to really talk about the end of your life or preparing and planning for what will come in the future when you don't really want to think about that aspect because its not something thats happy or you know. Its kind of a sad topic, but umm the way that Aging with Dignity presented itself was more in a positive way of trying to show that you can respect yourself and those around you because those who you are going to leave behind are going to suffer the most and I think thats most important because they're gunna be, when you are unable to take care of yourself they're the ones that will through this program will help you will take less responsibility on them. And I think it will ease the pain of the suffering.

Peter Brill: For those of you who don't know Marisa Scovosy is our Assistant Producer she's the one who schedules the shows, contacts the guests, gets all the information right?

Marisa Scovosy: Yes that is correct.

Peter Brill: That's been your job.

Marisa Scovosy: My job.

Peter Brill: And so, umm, let me ask you this Marisa, you have parents?

Marisa Scovosy: Um Hmm

Peter Brill: Do you think you are one day going to be faced with having to carry out their wishes?

Marisa Scovosy: Well, hopefully not too soon but probably, maybe depending on they're how well they're healthy. And things like that..

Peter Brill: Do you think can they live forever?

Marisa Scovosy: Yes, I hope so.

Peter Brill: When you're young you sure hope that.

Marisa Scovosy: Yea, but it probably is a very good probability that I will have to face some of these challenges  up ahead.

Peter Brill: So, it may be theres something for you to learn. Marisa is in her kinda between her first and her second age. Halfway in between.

Marisa Scovosy: Soon to be graduating.

Peter Brill: Well I wanted to talk a little bit, the programs going to be obviously on the topic we talked about but I wanna just talk again about what I'm beginning to understand from people in this stage of life. I talk to so many many people I communicate with so many, many people. You know, umm, when we start out this stage of life we were looking for a whole different level of gratification from a different place than we were before. We, you know, money and materialism only take us so far in life. I've asked people for example the following question and you might, listeners want to answer this question. What objects that you have bought, or been given have given you enduring pleasure or happiness? How many can you count, how many objects, literal objects can you count? And yet this society if you think about it, most people say very few. Less than a handful. And yet we're constantly acquiring and pursuing material wealth and material objects. Shopping. I mean I'm always amazed during the holidays at these scenes of people lined up at 5:00AM waiting to rush into, and that 40% of all purchases occur in this season. And I just want to ask us a question when finally we begin to break through of that, through with that and we begin to see that maybe our relationships with each other, maybe our relationships with our parents, our children's, our friends, our neighbors, the people you work with. Those things really matter to your happiness and what really matters to your happiness is what you can contribute to the world and to other people. However you can find, find something that serves your purpose in life. And can, do you have a sense of purpose. I talk to a lot people. Less than one in three have any sense of purpose for their life and yet its key to making them happy. And do you believe it is possible to have a life that is filled with joy? I ask you to stop and ask yourself that question. How many of you believe that its a really true possible goal or is it just one of these things that people put out you know and they say well you know the best you can do is kind of just not hurt a lot. The best you can do is if you have a life and you're sixty years of age and or sixty five or seventy and you're not in a lot of pain, your health is OK and your days kind of stretch one into the next and thats kind of the best it can be. I just reach out to you and say please reconsider. This is the most precious gift you could receive. It's called life. And to try to draw from it as much joy as possible and you can learn to draw a tremendous amount of joy from it. Anyway we work with that at the Third Age Foundation. We don't take any money in terms of uhh Dave and I take no salary from it. We do charge for our workshops. 969-9794 or you can look us up on (spells it out). So, what do you think?

Marisa Scovosy: I think thats a good message, I don't know. You always want to I think that the relationships that you have outweigh any material monetary things that you possess.

Peter Brill: Certainly over a lifetime they do. Don't they?

Marisa Scovosy: Yes

Peter Brill: I mean they change. It's amazing when you get to be my age how few the people that you knew when you were in grammar school, high school, junior high school are still in your life. But none the less the hour to hour feelings you have with people around you matter enormously.

Jarren Pelts: In lieu of a news story here Peter I just want to mention

Peter Brill: Oh Good!

Jarren Pelts: I heard a news story on this station.

Peter Brill: This is Jarren Pelts our...

Jarren Pelts: and uhh bout those people who perceive growing older as something positive.

Peter Brill: Uh Huh.

Jarren Pelts: tend to live up to seven years longer  is what I heard.

Peter Brill: Yes, absolutely.

Jarren Pelts: And what you were just talking about just made me think that. Just keeping that positive attitude and truly being happy so thank you, that was beautiful.

Peter Brill: It's been studied over and over if you approach the aging process with a positive attitude it totally changes everything.

Marisa Scovosy: It makes you want to be worth, or want to live for something.

Peter Brill: Our guest today is Paul Malley. He is the President of Aging with Dignity a national non-profit organization based in Tallahassee Florida. More than 8,000,000 American's have used Aging with Dignity's Five Wish document to plan in advance for a serious illness. Today's 5 Wishes is distributed by 10,000 organizations including physicians, attorneys, hospitals, hospices, employers, and places of worship. Paul Malley and the work of the Aging with Dignity have been featured in National Media including, are you ready for this list? Hold tight- CVS, NBC, ABC Evening News, CNN, MSNBC, NBC Today's Show. He should run for President- Good Morning America, USA Today, Wall Street Journal, New York Times, Newsweek, Time, and Consumer Reports. Now Why? That's the first question I've gotta ask you. First of all, welcome to the show Paul.

Paul Malley: Thanks, it's good to be with you.

Peter Brill: Now, why Consumer Reports?

Paul Malley: Why Consumer Reports? They didn't want to announce my Presidential bid I guess.

Peter Brill: Haha there you go!

Paul Malley: Consumer Reports, well they're supposed to tell people how to make good decisions right? So they featured a story about five wishes and saying their audience thinks about prudent choices and how to make good decisions for their family then these are important things to think about. How you would want to be cared for if you or someone you love gets sick.

Peter Brill: That's great. So umm what is Five Wishes?

Paul Malley: Five Wishes is a simple and easy to use document thats legally valid in most states including California. It lets you and your family make decisions about what you would want. Whats important to you if you get sick and you're not able to speak for yourself. It lets you make decisions about who would be your voice if you're not able to make your own medical decisions and to give them some guidance on how you'd want those decisions to be made whether we're talking about life support treatment that you'd want or not want right down to personal comfort care measures like what makes you feel comfortable. Where you'd like to be down to what kind of music you'd like to have played. Little things like that that are very important.

Peter Brill: So this is primarily when you're dying?

Paul Malley: Well it comes into play if you are very sick, and you are not able to speak for yourself. But it's something that all of us should think about. I heard you talking earlier and asking Marissa about whether she thought that this was something she could ask her parents. And I hope it is because this is really something that all adults should think about. What we would want to have happen in case we're sick, in case we're in an accident. Anything happens that we're not able to make our own medical decisions. Who would we want to make those decisions for us. And then what kind of guidance can we give to them to make sure they aren't grasping at straws and having family disagreements about what we would have wanted when right now today we can make those decisions and give that gift to our family.

Peter Brill: Yea, I mean I, for example when my father died he was eighty nine and he had end stage heart disease and strokes and all kinds of things and we talked to him and he really wanted a morphine drip at the end. I don't know whether it was legal or illegal and essential you know they gave him enough morphine slowly where he went to sleep. And later my sister got her nose all out of joint although she was in the room when we were talking about it and some kind of document that clearly expressed his wishes certainly would have helped.

Paul Malley: Sure and we talk about pain management in Five Wishes. You know, when people are asked it doesn't matter what part of the country you're in or really how old you are. When people are asked what would be important to you if you were sick and near the end of life. The most common answers are I want to be with my family, I want to be at home. I want my spiritual needs to be addressed, I don't want to be in pain. And one of the questions in Five Wishes asks you to think about that because its certainly fine to say I don't want to be in pain, but its important to be able to relate that to your family and to your doctors. It makes me think of one situation that I heard about when a husband and wife were filling this document out and the husband said well you know one of the most important things to me is to be awake and conscious and aware and able to communicate with the family for as long as I can and I'd be willing to be in some pain if it means that I'm still communicating with the family. And his wife looked at him and she said are you nuts? If it hasn't been said by then it's not gunna get said give me whatever you gotta give me I don't wanna be in pain. And they kind of looked at each other and had a little laugh and a chuckle about it but then they realized if they hadn't have had this conversation then they wouldn't have realized that about one another.

Peter Brill: Absolutely.

Paul Malley: You know, I think our automatic reaction is that if we're put in a place where we have to make decisions for someone whom we love and we don't have any guidance from then we're going to do the best that we can but our decisions are probably going to be based more on what we would have done for ourselves rather than what they might have chosen- simply because we haven't talked about it and we haven't asked and we're left to grasp at the straws.

Peter Brill: Well, So, Here's a I mean we'll get on to the general questions but I had to fill out one of these, you know I have one anyway but I had to fill out one cause I had a knee replacement and it says to you how long do you want to remain in a coma before your, in this case it would be my spouse pulls the plug. So I'm going to ask everybody here. How long would you want to be in a coma before we pull the plug Marisa?

Marisa Scovosy: Well I, if theres no chance of like ever coming out of it.

Peter Brill: Well how do you know?

Marisa Scovosy: Yea, you don't know. That's hard. I don't know a year?

Jarren Pelts: I think I worry the most about being a burden on my loved ones so...

Peter Brill: So a day?

Jarren Pelts: No, I'm sure, that  based upon the historical medical records there are certain averages that exist out there so I would trust several medical professionals. If several medical professionals believe that there was not a chance of me coming out I'd want that decision to be made.

Peter Brill: So Paul, what do you think?

Paul Malley: Well I don't know I think its a hard question to ask, a hard question to answer. We don't ask that in Five Wishes.

Peter Brill: Oh you don't?

Paul Malley: No, I don't.  I think it would be hard to answer and to put a number on it. Our approach is that we let you think about who you trust in your life to make those decisions. To appoint that person to name them as your health care agent and then give some instructions to them about if you know if I'm in this situation if I am in a coma then here's what I want you to do. Either I prefer to have life support treatment either I don't want it at all or I want it if I think it can help or my doctor thinks it can help or I want you to stop it if its not helping my condition or symptoms. But what we hope will happen is when you sit down with your family and you talk about this you'll have a conversation about it so that just as you were talking about it on the show here you might say well you know if its such and such amount of time and thats my thinking of what a long time is umm, but you need to get into the specifics on the conversation. I think it would be hard to put a number down on a piece of paper.

Peter Brill: How did you get into this?

Paul Malley: Well you know, I had my own personal experiences growing up watching my grandparents in many ways that they unfortunately did not age with dignity. I had two grandparents that spent many of their last years in nursing homes and sorry to say didn't get the best of care there. But you know I remember very distinctly one moment in my life and I was eight years old. It was three o'clock in the morning and the telephone rang at my house. And it was the nurse from the hospital calling for my mother. And the nurse on the other end of the phone told my mother that her father, my grandfather, was not doing well. And that she needed to think about what she would want the hospital to do if my grandfather's heart stop. Would you want to receive life support treatment or not, and the nurse said we know that this is an important thing to think about so go ahead and take some time but if you could please call us back in ten minutes we'd appreciate it and what to do.

Peter Brill: Wow

Paul Malley: You know I saw my mom, I remember peeking around the corner of the bedroom and looking in and seeing her on the edge of the bed that night in tears thinking what in the world do I do? Do I call my brother and try to build family consensus, or do I just make this decision on my own and hope everybody's not mad at me tomorrow morning and oh yea, what would my dad want because we never talked about this.

Peter Brill: Um Hmm

Paul Malley: It was an awfully hard night.

Peter Brill: Boy it sounds that way.

Paul Malley: And we learned from that experience and we were able to have that conversations with my other grandparents umm just because it's not going to make the situation perfect. When somebody in your family is sick its a hard situation but it doesn't have to be so hard that it tears families apart because.

Peter Brill: We're going to have to tear this family apart right now

Marisa Scovosy: Yea

Peter Brill: because we're going to have to take a break and go for a commercial here. So you're listening to Third Age and we'll be right back.

<commercial break 18:00-18:25>

Peter Brill: Well we're so glad you're back with us. Welcome back to The Third Age I'm one of your co-hosts Dr. Peter Brill and I'm here with Marisa Scovosy and we're talking to Paul Malley who's the President of Aging with Dignity which is an organization that helps people deal with death and dying and illness so that the families can communicate and understand what people's wishes are. Marisa you had a question.

Marisa Scovosy: So how did Five Wishes come into existence? What started it?

Paul Malley: Well the document was created by a man named Jim Tewey who founded our organization Aging with Dignity and Jim was legal counsel to Mother Theresa of Calcutta. He worked with Mother Theresa for about 12 years and lived in some of her homes for the dying in Washington and Calcutta and he saw there in that experience that dying is more than just a medical moment. And he related that to the way that we care for people here in the United States so often. When medicine and medical issues obviously are very important we want to make sure that we get the best medical care possible. But so often we forget the personal elements. And earlier in your show you were talking about what really matters to people in the third age when they start thinking about the purpose in their life and the meaning and so often we're turned to our relationships it's the relationships that matter. So in Five Wishes we wanted to include more than just the medical issues about questions of life support treatment or who makes medical decisions on your behalf. We wanted to talk about family relationships and if you are sick and near the end of life what kind of environment would be comfortable to you and what things would honor your human dignity. So it can be very serious. You're talking about life and death matters here you're talking about personal relationships. But it can also be umm kind of interesting too because there are several questions in Five Wishes that give you the chance to say that you'd like to have people with you when possible. A lot of people write in the margins there a list of people who they'd like to be by their side if they're sick and sometimes there is a second list of people who they don't want there and that makes for some interesting family conversations but you know its all about creating an environment that makes you feel comfortable that lets your loved ones know hey if my mom or dad is sick here's what they asked for and heres what I can do to honor their wishes.

Peter Brill: You know I just want to take off your website what you say: Five Wishes let your family doctor know and then it lists five things. Maybe you'd rather say them or should I just read them.

Paul Malley: You're either way.

Peter Brill: Oh, go ahead if you know them by heart.

Paul Malley: Sure, I do. I've talked about them a few times. The first wish is similar to what some people might know of as the Durable Power of Attorney for Health Care of Health Care Agent. Those are the legal terms for it. We kind of translate that and put it into regular language and we call wish one the person who I want to make health care decisions for me when I can't make them myself. So what you're doing here is you're picking someone in your life. It may be a spouse, it may be an adult child, it may be a close friend and you're saying I trust this person to make my health care decisions if for whatever reason I can't make my own medical decisions. That could be that you're very sick, it could be that you were in a car accident and just temporarily are not able to make medical decisions but you're naming that person and the important thing is that you tell them that you've chosen them to be your health care agent and tell them a little bit about what's important to you and how you want them to make medical decisions if they're put in that in that position where they have to make decisions for you. But theres an option in Five Wishes where you can name a second choice and a third choice and a whole list of things that that health care agent can do.

Peter Brill: I want a committee of one hundred I think.

Paul Malley: A committee of one hundred, good luck.

Peter Brill: I'm signing up people by the way.
Paul Malley: You're one hundred closest friends right?

Peter Brill: There  you go, what's the next one?

Paul Malley: The next one is the kind of medical treatment I want and don't want. And this is similar to what people probably know of as the living will. Because it asks you in these certain situations if you're near the end of life, if you're in a coma if you have persistent brain damage what are your thoughts about life support treatment? When would you want it, when would you not want it, and there are blank lines there so you can customize this massage so you can say here's what I mean when I say life support treatment and here's what I want you to know when you make medical decisions on my behalf. The third, fourth and fifth wishes are all some of the things that really set this document apart because these get into the personal care preferences. Wish Three:my wish for how comfortable I want to be. This addresses the issue of pain management that we talked about earlier. I wish to have my favorite music playing if possible. I had one person a nurse who is Maryland she said when she filled this out with her husband he said he wanted Ana gotta Davita playing. And she said you know that was a surprise, but if thats what he wants so be it, I'll do it. But little things like that when people first think about it seem kind of corny or goofy but you know what? When people come back to us and tell us stories about caring for a loved one who had filled out Five Wishes it is those little things that people talk about.

Peter Brill: Have you got a story just an (inaudible) before we finish the last two. A story about where this went well, where this was used well?

Paul Malley: Sure, there are lots of them. One that stands out came from a woman in Massachusetts who told me that her husband had filled out Five Wishes. He was in his sixties, healthy no reason to think anything was going wrong six months later he had a massive stroke and he was in the hospital for the last twenty eight days of his life and she said what they did was they kept Five Wishes on his bed stand in the hospital so that whenever a doctor or a nurse came in she said I don't care if they looked at that document for thirty seconds if they glanced at it they knew my husband better than when they first walked in the door. And he had written things in there like he wanted to have pictures of his grandchildren with him and she said before the nurses looked at Five Wishes they'd see the pictures of his grandkids on the nightstand and take them down so they could put the medical equipment there but she said after they looked at Five Wishes and they saw that he asked for these pictures of his grandkids to be there they didn't take it down anymore.

Peter Brill: You know the other thing I've found being a physician in the hospital is that to the extent that you can keep  yourself as a human being to the people treating you they treat you differently.

Paul Malley: Exactly. Yep.

Peter Brill: So it makes a big difference. Ok, what's the last two?

Paul Malley: Last two. Wish number four is my wish for how I want people to treat me. Lets just say I want to have people with me. I want to have people praying for me. You know sometimes people say yes I want people praying for me tell my church, my congregation that I'm sick that I want prayers. Other people say I don't want anybody knowing my business don't tell anybody about it. I don't want people praying for me. It's a personal question and this is the place where you can say that and express matters of the heart that would let you tell people what makes you feel comfortable and how you want them to treat you. And wish five goes even further into the matters of the heart letting you tell your family, your loved ones what you want them to know. Like, I want my friends and my family to know that I love them. That I forgive them and that I wish to be forgiven for the times that I may have hurt them. How I want to be remembered. These types of little things that you could write a sentence for you could write pages and attach them to this document.

Peter Brill: Can I just disagree with you on one point? These are not little points. I've treated so many people and I've talked to so many people and I've had groups with so many people where at the end of life there was never the statement of forgiveness between parent and child. We've, we're actually finding in adult children of you know with parents and children in this stage about seventy percent are isolated or alienated from one or more of their adult children.

Paul Malley: That's true.

Peter Brill: So these. I mean. And the other thing I found that I really strongly urge people to think about is what do you want your children to know about you. People don't take the time to write their lives down. To transmit what their experience of life and what their values are to other people. Thats a wonderful question.

Paul Malley: Yep, thats true and you know that makes me think of this of an example of a woman who said that her husband when he filled out wish five had put a big asterisk next to the point that says I wish for my family to make peace with each other if that's possible before I die. And she said it didn't happen before my husband died but that same day my sons who had not spoken in five years spoke and

Peter Brill: Oh wow!

Paul Malley: mended their broken relationship because it was their father's expressed wish.

Peter Brill: That is so wonderful. I mean you know, we had an uhh lawyer that we talk to who tells the story about three quarters of when the second parent dies three quarters of the families are in some kind of basic huge struggle over the estate which is all the leftover feelings that never got resolved in these families.

Paul Malley: Umm. It's true.

Peter Brill: It's really very very sad.

Paul Malley: And many siblings that don't speak to one another after the parents have died because they had a big fight about

Peter Brill: Yep Absolutely.

Peter Brill: what the parent would have wanted whether its medical care, estate or otherwise

Marisa Scovosy: Exactly. Alright well we're going to go to commercial break and you're listening to Paul Malley on The Third Age Radio Show. We'll be back

<commercial break 27:50-28:15>

Peter Brill: Welcome back to The Third Age I'm one of your co-hosts Dr. Peter Brill. I'm here with Marisa Scovosy and Paul Malley who's the President of Aging with Dignity. Paul, welcome back. How do people take advantage of your organization's services and what can they do to help you?
Paul- couldn't talk could you- the button. We silenced you, finally.

Paul Malley: Yea, they take me off mute.

Peter Brill: Oh it was one of your five wishes I'm sure.

Paul Malley: There  you go, let me speak.

Peter Brill: Let me speak, great! What, how do people take advantage of it and how do they help your organization?

Paul Malley: Well a lot of times we hear from individuals and families that contact us because they've heard about five wishes and they say this is something that would be helpful to me and my family. Umm, the documents are available for just a small charge. They're $5.00 each and we have some DVD's that go along with it for people that are interested in getting more information. We actually have a new resource that we are offering this year and they are new translations. The Five Wishes Document is now translated in twenty different languages and we did that with help from a grant from the United Health Foundation and those are available for free and they're languages from Spanish of course Chinese, Japanese, Hindi, Arabic, Muong, on down the list so we're happy to be able to provide those documents to people who speak different languages who probably didn't have a document that helped them make these decisions in their terms.

Peter Brill: So how do they get them from you?

Paul Malley: Well, they can either call our office and there is a national toll free number 1-888-5WISHES, 1-888-594-7437

Peter Brill: Let's do that again. 1-888

Paul Malley: 1-888-594-7437

Peter Brill: Or do you have a website that they can...

Paul Malley: Yep the website is, so that's aging with dignity all spelled out dot org and you can order copies there, find out more about our organization and the other resources that are available.

Peter Brill: Great! Marisa you had a question.

Marisa Scovosy: Yea, well with the different languages that you have to translate are there cultural differences that you have to present as you're communicating the five wishes or are they basically the same?

Paul Malley: Well the questions are basic enough that it allows a person to express their own cultural preferences in the answer. So it might ask things like and depending on the culture there will be very different answers for who you would want to have in a room with you. So this document does a good job of asking the questions that allow you to communicate what's important to you culturally, spiritually, family relationship wise whatever the case may be. So its the same document in all languages (being interrupted by below comment)

Peter Brill: Now if you're Hindu do you get to choose what you want to come back as next life?

Paul Malley: I don't know I haven't heard any comments about that one so far

Peter Brill: So we were having a whole discussion at the break here about how people, you want to come in Jarren? We were talking about how people wanted to deal with this period of life.

Jarren Pelts: Well I'm a believer. I believe I have a lot of faith in my loved ones and if you know upon all of their judgment and certainly I don't think it should be in any one person's responsibility although legally you have to create a document where one is in charge umm you know believe beyond a reasonable doubt that you're not going to be able to have the same quality of life I don't think they would let me suffer. So, I don't think theres need for that so drug me up.

Peter Brill: Lisa you wanted to have your chance?

Lisa Hedly: Yea, we were just talking about this during the break and I would agree with Jarren too I mean if I was right towards my end I would just rather be totally drugged up and ready to head on out and say my goodbye's to everybody.

Marisa Scovosy: I think I would want the same too but uhh comes to the question of the second wish of like the kind of medical treatment you want and don't want and I have a question for you Paul. What if it's an illegal kind of medical treatment like assisted suicide what happens there?

Paul Malley: Well, thats, the assisted suicide is obviously not an option in this document because this document is a legally valid document in most states and in all the states where it meets the legal requirements Five Wishes, that is not a legal option. Our hope would be that if someone were thinking along those lines and thinking perhaps maybe they didn't want to be a burden to family or they were afraid of dying in pain or dying a miserable death that in talking through Five Wishes and in looking at the document and expressing their preferences to their family and with their doctor they'd have some peace of mind to know that their wishes would be followed. Not only medically, but just to know that they would be accompanied with this process. So often when someone says they'd like to look at the option of assisted suicide they do so because they think that their, the only option is a miserable death alone and in pain. And we would hope that this conversation would let people know that there is an alternative, a compassionate one. That they could be accompanied in that process.

Peter Brill: Hmm. Very very interesting. So have you written your five wishes?

Paul Malley: I have, yes, and my wife has as well and we've talked about it with our parents and my wife and I actually are getting ready, we have a baby coming in March and this is our fourth and we'll have the living will and Five Wishes document with us when we go to the hospital because you're supposed to take it with you every time you go to the hospital and it will be in her medical chart.

Peter Brill: Anything you want to share with us?

Paul Malley: From my medical document?

Peter Brill: Yes.

Paul  Malley: Well you know, I think you know, you'd talked a little bit about relying on your family members and having faith in them to know that they would make the right decisions. You know and I found myself in a similar situation where I did want to make sure that my wife knew that obviously I wanted her to make decisions on my behalf but I didn't want to leave her hanging without any kind of instruction from me, so we did have a good down to earth, heart to heart conversation about what I would want and what I would want her to know in making that decision. And I think thats important for families to have that conversation. Even if you think yes, I trust my husband, my wife whoever the case might be it's important to not just leave it at that but to give them some instruction about what you would want and how you would want them to go about making decisions.

Peter Brill: Yea. I really. You know I'm going to be sixty-five on Medicare very soon here and so my wife and I are spending more time certainly than we did ten years ago talking about what life could be like without one or the other of us and there are many many issues that that brings up and to talk through you know how do you handle finances? How do you handle the children? Remarriage. I'm really amazed at how few people talk about whats really important in life.

Paul Malley: And its hard. Sometimes its hard to just get over the hump of starting the conversations.

Peter Brill: It sure is, this is our life together and we certainly want to do it. Lets give the number one more time for how to people access you and I assume you take you're nonprofit, you take contributions.

Paul Malley: We do, and we're certainly grateful for that. The small amount of income from the Five Wishes does help us and we're grateful for the individual support as well for Five Wishes and our other programs.

Peter Brill: So how do they reach you?

Paul Malley: The national toll free number is 1-888-5WISHES, 1-888-594-7437 and the website is

Peter Brill: Well you have any last words you'd like to say? We have about a minute?

Paul Malley: Well I think for those who are listening to this program and maybe thinking yes this sounds like a good thing to do I'll do it someday. I would just encourage you to take the action right now whether it's calling us or talking to you doctor local hospital or hospice about it. Put something down in writing. Its far better to do it right now than in the middle of a health crisis.

Marisa Scovosy: Alright, Well thank you so much Paul Malley.

Paul Malley: Absolutely

Marisa Scovosy: We'll be right back, come join us again umm this is Marisa Scovosy from Third Age Radio Show with Dr. Peter Brill.

<commercial break 36:40-37:20>

Peter Brill: Well welcome back this is The Third Age I'm one of your co-hosts Dr. Peter Brill we have Marisa Scovosy who's sitting in for David Debin today. We've had a very heavy show today. We have one more heavy little statement that Lisa who's running our board today wants to share with you.

Lisa Hedly: We were just discussing about death today and just recently my brother in-law passed away last year and he was just sixty-two years old. He came back from Europe with a stomach ache and it turned out to be stage four Pancreatic Cancer and it metastasized all of the major organs. Well we had, we would fly back and forth to Houston to be with him but during those last few months he, umm he had wrapped everything up he did have time to say his goodbye's, do his paperworks and make his wish list but he wanted to go and to wake up every morning and not know was it the day, was it the time, was it the minute and to have his family continually come in and get these phone calls in the middle of the night was very difficult and for me personally I would like the choice if I ever came to that for assisted suicide. I would not want to just wait it out and wait it out in all that pain and agony. So, anyways that is what we were talking about during the break.

Peter Brill: Yea. Marisa what do you?

Marisa Scovosy: That's a really hard decision but to like face the deadline never knowing when you're gunna go or not umm I think I would probably want to go along the lines or at least be surrounded by family and friends as I'm suffering although its hard when you are physically suffering and you can't really do anything about it or control your emotions or pain at that time, but I'd probably want, probably have a deadline or at least I guess it all depends on how religious I become later in life because that also plays a factor I think.

Dr. Peter Brill: Yep. Well it certainly was a very tough topic we were doing this period. We wanted to include it for two reasons. First of all we wanted to make sure that those of you in the third age listen to the advice of Paul Malley if you haven't discussed these issues, if you haven't prepared these things in writing you certainly need to. But also I think that illness and death are a great reminder if we can face them squarely and we can face the truth that they'll come when they come in our lives that we want to make this time of our life the absolute best that we can possibly make it.

Marisa Scovosy: Like the movie that's coming out- the Bucket List.

Dr. Peter Brill: Yea, what is this?

Marisa Scovosy: The Bucket List I think is with Jack Nicholson and I forget the other person but they basically know they have a limited amount of life and they're basically just trying to live out all the wishes that they've never done in their previous, that they've never done before and they want to make the best of the end of their life.

Peter Brill: Alright you want to have a little thing here guys, one wish- if this is it?

Lisa Hedly: Hmm, one wish. My wish would be that I would be surrounded by all of my family before- even my dog.

Peter Brill: No, the wish, I mean the undone thing, the undone thing.

Lisa Hedly: Oh the undone thing.

Marisa Scovosy: Oh the undone thing.
Lisa Hedly: That wish- Hmm, That wish? Oh  I would love to probably go back to Rio De Janeiro
and just lie on the beach and sip a wonderful exotic cocktail. I mean that would be my one simple wish. Very Simple.

Peter Brill: Your wish is granted, we'll do that for you.

Lisa Hedly: Alright

Jarren Pelts: I have a travel wish too.

Peter Brill: Ok

Jarren Pelts: I just want to end up in Tuscany.

Peter Brill: Tuscany

Jarren Pelts: You know what, just end up there. Become part of the soil and you know, or have your ashes scattered across the land there and become part of something so alive and rich again.

Peter Brill: Marisa?

Marisa Scovosy: Maybe since I'm scared of it, to go skydiving.

Peter Brill: Skydiving huh?Alright, my wish is to go to the moon.

Marisa Scovosy: That's a good wish.

Peter Brill: If I could go to the moon I would just, my father said to me once he says  that's fine you can go to the moon I'm just not coming to visit you.

Marisa Scovosy: That might be possible now aren't they like thinking of ideas of having?

Peter Brill: Yea they are but I think getting into orbit is going to be the first thing that is going to be possible.

Marisa Scovosy:Yea, that's true.

Peter Brill: I've always wanted to go into space.

Marisa Scovosy: That would be awesome

Peter Brill: I want to also thank Marisa for putting together today's show and sitting in and Jarren Pelts and Lisa Hedly. Thank you for your help today.

Jarren Pelts: Thank You Lisa Hedly.

Peter Brill: Hedly,

Lisa Hedly: Umhmm
Peter Brill: and we'll be back next time for another journey on Third Age.