Those of you who were in synagogue on Yom Kippur day (or read my sermon) know that I encouraged you by personal example to speak frankly with your loved ones about your desires for your medical care and treatment should you become (God forbid) unable to express yourself. More than a list of instructions commonly called an "advance directive." this conversation is as much about context as it is about instructions.

The conversation is hard. very hard. Even the most rational among us feels threatened by invoking the possibility of separation and death, though we all know that disability and dying cannot be provoked by talking. For a young adult, the prospects of personal death are unreal, but the inevitability of losing an older loved one is frightening. For an older person. incapacitating illness or death may stir up deep fears, and the desire to protect younger loved ones from encountering that fear too soon is palpable.

So I offer you one of many ways available to help you with this necessary exchange. It is called "Five Wishes," and you can find it here:

http://www.agingwithdignity.org/five-wishes.php (summary below)

This excellent web site and format has only one drawback. The document available for an individual to complete may persuade you that the face-to-face conversation is not necessary. However, the decisions you make about your care are of little value if the people charged with honoring them do not have your direct instructions and permissions about following through. The conversation is essential.

I did not include in my sermon a discussion of how I began to think about the topic. To be honest. it was the result of President Obama's initiative to reform health care. In every forum I encountered. a single theme was consistently sounded: the greatest expenditures on an individual's health care typically occur in the last six months of life. Often - more often than you can imagine - that care involves very expensive treatments that neither prolong a person's life nor improve the quality of those last months. Among those cthorts of people who have addressed their own end-of-life desires directly, the quality of their last months increases and the cost of their health care plummets dramatically. Individually, your efforts can make your loved ones' lives better. Collectively, these efforts can have a positive impact on any configuration of health care. regardless of the politics of the situation.

It has been three months since Yom Kippur. Whatever emotional impact or persuasive arguments I made have faded. Life has taken over and these concerns have receded to your back burner if you have yet to act. And while it was gratifying to me to hear the praise so many of you offered for my sermon and the personal vulnerability I showed. your appreciation would mean much more to me if I knew that it inspired you to act.

The Jewish New Year is a memory and the secular New Year is past. No occasion for you to make a resolution will arrive again for a long time. So please. be courageous and show the love - for your loved ones, for yourself and for our society.

Five Wishes lets your family and doctors know:

__Who 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.