Many people have expressed to me their desire for a dignified death for themselves and their loved ones. This is a challenge in a death-phobic culture where life at all costs (physically, emotionally and financially) is the norm. Too many of us know someone whose dying time was a torturous descent into a medical quagmire.

In this column, I write about some actions that each of us can take to better assure a dignified death on our own terms. The caveat is, for any of my suggestions to be useful, each of us must be ready and willing to die when our time comes, which requires a wisdom of when that time has arrived.

The first step is to fill out advanced directives. These are documents that spell out our end-of-life wishes should we be incapacitated and unable to do so; and, who we declare as our durable power of attorney for health care. These documents need signed witnesses. The first document is called a living will and the second a health care proxy. These are documents that vary in content from state to state and also need to be notarized. For Massachusetts, go to www.caringinfo.org/files/public/ad/Massachusetts.pdf. There is also a document called "The Five Wishes" that will serve both purposes: agingwithdignity.org/docs/default-source/default-document-library/product-samples/fwsample.pdf?sfvrsn=2

The next level of documented wishes is a POLST (Physician's Order for Life-Sustaining Treatment) or a MOLST (Medical Orders for Life Sustaining Treatment). The term varies depending on which state you live in. This form is signed by a physician and is usually filled out when one is terminally ill. However, anyone at any stage of life can fill this out if you have a medical practitioner willing to sign on. In its most extreme, it directs that nothing be done in a life-threatening event. Should 911 be called and paramedics appear, this document should prevent any life-sustaining actions including an emergency room visit.

Some of us can imagine wanting medical aid in dying during our dying time. This is known as the Death with Dignity statute that is legal in five states in the United States. To qualify, one must be terminally ill, competent and have a six-month prognosis. If this is important to you and you do not reside in a state where aid in dying is legal, then you might consider joining the organization called Compassion and Choices to be involved with getting the bill passed in your state of residence: www.compassionandchoices.org. There are issues with this path to a dignified death. There may be a shortage of doctors who are willing to be involved. Given the condition of the patient, it may be impossible to swallow the medications necessary to end one's life. There are also on-going issues with pharmaceutical companies regarding the manufacturing, distribution and pricing of lethal drugs. The intention of the bill is dignity but its application can be fraught. It has been legal in Oregon since 1997 with no documented abuses.

Finally, there is choosing to end one's own life. This is legal. Assisting someone with ending his life is illegal depending on how "assisting" is defined. This choice is for someone who does not want his death to be a medical event and considers this option as a rational and sane response to illness and aging. For those of you who want to learn more, check out The Final Exit Network at www.finalexitnetwork.org, or Exit International: exitinternational.net. These organizations understand this choice as a civil right.

Now is the time to think about an end of life plan.

Deborah Golden Alecson is a death, dying and bereavement educator and speaker who resides in Lenox. She is the author of three books that deal with her personal loss. Learn more at deborahgoldenalecson.com.