If I Only Had 12 Months to Live
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I have long admired Jonathan Clements. His columns in The Wall Street Journal introduced me to index-based investing. I have been a subscriber and avid reader of his aptly named HumbleDollar newsletter for many years.
While I’ve never met him in person, I have contacted him on several occasions, and he has always been gracious with his time and willing to share his insights.
I was deeply saddened to read his column in HumbleDollar, dated June 15, 2024, that, at age 61, he has been diagnosed with lung cancer that has metastasized to his brain and “a few other spots.”
In a related LinkedIn post, he asks, “What would you do if you were told you might have just 12 months to live?”
That got me thinking.
What would I do?
Confirm the diagnosis
Initially, I would want to confirm the diagnosis and ensure I was receiving the best treatment available.
Just like we tend to favor stocks we know, we are biased toward medical care available locally. That may be fine if we are fortunate to live near a major medical center.
If not, after doing some research, I would travel to one of these facilities:
- Mayo Clinic
- MD Anderson
- Memorial Sloan Kettering
- Cleveland Clinic
- Dana-Farber
- Johns Hopkins
Assemble my team
I would assemble a team to help me while I’m alive and assist my wife after my death. It would consist of the following:
- A financial advisor
- An estate planning attorney
- An elder care physician
- Hospice/palliative care
- Our accountants
Depending on my mental state and my wife’s, we would consider adding a therapist to help us emotionally.
The role of these professionals is self-evident, but the need for a financial advisor deserves special mention.
I don’t know if Jonathan has a financial advisor. He doesn’t need guidance on how to invest.
In my case, I would need to retain one. My wife is quite sophisticated in financial matters and is thoroughly familiar with our situation. I’ve tried simplifying our portfolio to make it easier for her after I’m gone.
Yet, I know issues will inevitably arise that I didn’t contemplate. They may only relate to ministerial matters (like moving money from one account to another), but she will need someone thoroughly familiar with our accounts.
It would provide peace of mind to both of us.
A good death
I would tell my loved ones and my care team that when the time comes, I want “a good death.”
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Dan’s new book for millennials, Wealthier: The Investing Field Guide for Millennials, is now available on Amazon.
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A “good death” varies depending on individual preferences. Most would like to “die well.” A review in the American Journal of Geriatric Psychiatry (discussed here) discusses how many define that term.
Here’s what it means to me.
I want my preferences for medical interventions, the presence of family members, and the environment where I wish to die (home or in a hospital) respected.
I want to be free from pain and suffering. Effective pain management and palliative care can make this possible.
I want to be treated with dignity, respect, and deference to my wishes.
I want to minimize the burden on my family of the dying process to the extent possible.
I want to retain control over decisions related to my care and how I choose to die.
How to cope
If my prognosis was bad, I would need to reflect on how I want to cope.
I object to using the term "fighting" a disease because it’s misleading and unfair to the patient.
It implies that the outcome of the disease solely depends on the patient's willpower and effort, which is rarely the case.
Using this militaristic metaphor places an undue psychological burden on patients, making them feel responsible or guilty if their health does not improve despite their best efforts. It oversimplifies the complexities of diseases, ignoring factors such as genetics, environmental influences, and the inherent nature of the illness itself.
It can also marginalize those who succumb to their illnesses, suggesting they did not "fight" hard enough, thereby adding to their and their families' emotional distress.
Depending on the diagnosis and prognosis, I might “capitulate” instead of “fighting.”
I’ve had personal experience witnessing lingering deaths with long periods of suffering at the end of life. It’s not something I want to emulate.
The daughter of actress Diana Rigg wrote poignantly on this issue when describing her mother’s agonizing death from cancer. Here’s an extract:
“But it was the indignity of incontinence which made my mother want to end her life. For her, and I know this isn’t the same for everybody, the tipping point in her quality of life was the inability to control her bowels. It depressed her so completely that her dignity was, on a daily basis, stretched beyond breaking point. She simply didn’t want to be here any more.”
While this is an intensely personal issue with profound ethical and religious ramifications, I feel the same.
I live in Florida, where there are no assisted dying options, so I would explore alternatives. You can find a good summary of end-of-life options in different states in this article from the Senior Lawyers Division of the American Bar Association.
Vermont has a “Patient Choice at End of Life” law. If a Vermont-licensed doctor certifies that death is likely within six months and the patient can self-administer a prescribed lethal dose, they can terminate their life.
Vermont is somewhat unique because residency is not required to take advantage of this law. Guidelines for nonresidents and their doctors can be found here. Other states have either removed the residency requirement or are considering doing so.
As he struggles with this health challenge at an all-too-young age, I wish Jonathan Clements the strength to endure, the courage to face each day with resilience, and the comfort of knowing he has positively impacted the lives of millions of investors.
Dan Solin coaches evidence-based financial advisors on how to convert more prospects into clients. His digital marketing firm is a leading provider of SEO, website design, branding, content marketing, and video production services to financial advisors worldwide.
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