Who Will Control Your Care When There Is No More Cure?

Exercising your freedom at the end of life through advance directives.

How do you make your wishes known when you are unable to speak for yourself? Who will be your voice? Advance Directives inclusive of Living Wills, Healthcare Power of Attorney (HCPOA), in combination with instruments such as Cardiopulmonary Resuscitation, (CPR), Do Not Resuscitate (DNR) orders, artificial feeding (gastronomy or G-tube) and Intravenous (IV) hydration orders can be your voice.

As a hospice and hospital chaplain, I have witnessed nurses and physicians that have the incorrect understanding of end-of-life medical issues and the appropriate way of addressing these issues. At this point, you are probably asking yourself “How could this be possible?” and “How can a chaplain make these types of observations?” The Healthcare industry for the most part is starting to learn that issues at the end-of-life are different from when we are “healthy”. First let me describe what I mean by end-of-life issues. End-of-life generally and loosely defined starts about one to three months prior to death. It consists of “withdrawal from the world and people, decreased food intake, increase in sleep, going inside of oneself, and less communication.” (Karnes 1986) The state of “actively dying” typically starts when a patient is in the last two weeks of dying. During this time the body, spirit and soul prepare for the transition of death. Prolonging the dying process for the benefit of family members is as wrong, in my opinion, as hastening the process.

By making our wishes known through advance directives, we protect ourselves from receiving medical treatment such as CPR when we are at the end-of-life and when it is more harmful than helpful. Two main advance directives are the Living Will and the Healthcare Power of Attorney. The Living Will is a document that directs your physician as to your wishes under specific circumstances such as not receiving CPR if that’s your wish. The Healthcare Power of Attorney is a document that accomplishes the same things as a Living Will but goes beyond it to identify a person(s) that you trust to carry out your wishes when you no longer have the capacity to express them yourself.

The advanced directive I encourage people to use is actually a combination of both the Living Will and the Healthcare Power of Attorney plus it has additional areas where you can express your spiritual and emotional issues as well. This document is called “Five Wishes” published by Aging with Dignity(http://www.agingwithdiginity.org/). This is legal in 38 states including Illinois. It can be made legal in the other states by completing the state’s HCPOA short form and attaching Five Wishes as an addendum to the state form.

Five Wishes consists of your response to the following issues:

• Wish 1 - The Person I Want to Make Care Decisions for Me When I Can’t;·
• Wish 2 - The Kind of Medical Treatment I Want or Don’t Want;·
• Wish 3 – How Comfortable I Want to Be·
• Wish 4 – How I Want People to Treat Me; and·
• Wish 5 – What I Want My Loved Ones to Know.

If you value your right to define in advance what you do and do not want to happen when you are unable to speak for yourself, rather than allowing the state to do so, then take the time to give your loved ones a gift and complete your advance directives while you are able.If you or your organization would like assistance in completing this advance directive please email me at kenhinz@kenhinz.com. I would be happy to arrange that for you.
God Bless
References Karnes, RN, Barbara. 1986. Gone From My Sight. Barbara Karnes Books: Depoe Bay, OR 97341