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The Ultimate Advance Directive

By January 25, 2022Humility, Longevity, Philosophy

A short story by Stuart Greenbaum

[Disclaimer: This story is a work of fiction. While the perceptions and insights are informed by professional and personal experiences, no connection to real individuals or circumstances should be inferred.]

No one can know absolutely how they will think or act as they age into their future. Of course our younger selves are arrogant enough to think we do. But really no matter our predilections, things will inevitably and unpredictably change between our younger now and older yet-to-be.


What I know today is this, I’m losing my mind. I’ve been diagnosed with dementia and the likelihood of full-blown Alzheimer’s on the horizon. My brain is under attack. Rebel proteins have surrounded my head-quarters, methodically choking off brain cells and indiscriminately looting my precious memories.

The well-documented early symptoms of Alzheimer’s disease are impaired memory, language, concentration and task completion. The brief heart-wrenching purgatory of self-awareness of one’s decline is followed by oblivion, the result of a body and mind meltdown. Which is followed certainly by what seems to me, at least, to be a very undignified death.

So yeah, this is not going to end well. Of that I’m sure. My mother suffered from Alzheimer’s. She gradually lost everything — keys, dates, names, dignity. She needed help to do everything. She forgot how to think, how to go the bathroom, how to eat.

My turn is coming, and the prognosis is hopeless. It isn’t pretty now and it’s only going to get uglier. The least I can do is prepare my future self. With an empathetic note, which I have strategically placed in a secure place, somewhere not too obvious yet accessible.

My desire is that for the next few months or so when I occasionally find this envelope, I will be relieved. But when the time does come, when I discover this curious envelope, I hope for this reaction. I will read and, without knowing why, follow the explicit handwritten instructions:


Before I put the lethal cyanide capsule in my mouth and swallow — and I know this is desperately optimistic — I wish to enjoy one final moment of lucidity during which I brush my teeth and comb my hair, put on fresh underwear, and sit down comfortably in my favorite chair surrounded by photos of family and places I’ll pretend to remember.

And then, the past and future and present me will reconvene in this day, the day I end.


I do appreciate the inherent disrespect of projecting my current wishes upon my future self. Of guarding my destiny with this ultimate advance directive. I am, however, making a willful, deliberate decision to trust my current, healthy cognitive judgement.

Further, this is not in any way meant to disparage others who consciously choose or unintentionally accept otherwise. In fact, I sincerely regret on occasion being (and no longer am) the sort to visit a nursing home and upon seeing the sad state of the infirmed would mutter to myself “If I ever … just put a pillow over my head.”

But aren’t you being selfish, some will say? To the contrary, I believe. I do not want to be a burden or source of others’ discomfort, stress or sadness. More importantly, I do not want to obligate family members to jeopardize savings for their own future to cover my exorbitant care expenses if my funds run dry.

Finally, this, which I concede is selfish. I want memories of me to be healthy and joyful.


What if the next time researchers enthusiastically announce a cure for Alzheimer’s disease is forthcoming, it really is?

       OH SHIT … where’d I put that suicide pact?!


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