Thursday, March 20, 2014

Advance Directive

I haven’t yet written my personal advance directive. I thought that doing it here, not only would it be in print, I would have the chance to define some terms my own way. So here goes.
image from here
If a time ever comes that I am in a hospital on life support, I DO NOT give permission for life support to be removed to hasten my demise.
Here are the basic reasons:
·        I believe the decision about when I die belongs to God, not to me or any other person or entity (exception: if I were to commit a heinous murder and had thereby subjected myself to capital punishment—but I think that scenario is easily avoided).
·        I reject the premise that a person deserves the “dignity” of choosing the time, place, and circumstances of their own death. How does usurping that authority from God make you more dignified, rather than simply unwilling to trust God?
·        I reject the premise that people who are a “burden” on their loved ones, or on society, have committed a capital offence.
·        In addition to the above, I reject the premise that, since good people don’t want to “burden” their loved ones or society, euthanasia is the preferred option to alleviate that guilt.
·        I have experienced a long history of failures by medical experts; I don’t automatically trust their opinions about whether healing can come. I believe in miracles, and I don’t want to rule out that possibility. I also believe that the brain can respond to stimulation and exercise, and is worth trying to rehabilitate.
·        When it is time for the Lord to take me, I want to go in harmony with Him, knowing that even in the difficult last hours, I did not rebel against Him and insist on my own way.
·        I absolutely DO NOT want my family members burdened with the decision to overrule God.
·        I refuse to let anyone imply that I have given permission to medical personnel to decide I am not worth treating. If medical personnel or government bureaucrats (death panel) try to take that decision upon themselves, I want them to know that I expect them to stand judgment before God for undervaluing my life (or anyone else’s).
Now, I think we have to define some terms. We think we know what life support is: machines maintaining life that would otherwise not continue, so it’s artificial life and not real life. But in reality, life support has some specific aspects.
One is air. We need to breathe. In older times simply the absence of breath was the indicator of death; there wasn’t a remedy. Now we can provide oxygen and help a person breathe. Usually this is expected to be temporary, but there are a number of people, often elderly, who are able to go about their lives as long as they bring along their oxygen tank. They’re conscious, definitely alive. Without the oxygen, they would likely soon die, but with the oxygen they can enjoy their life for possibly a number of bonus years. So a life on oxygen isn't by definition an artificial life.
Another is heartbeat. Lack of heartbeat is another indicator of death. But sometimes a stopped heart can be restarted. Worth trying? To the millions who have responded to defibrillators, probably so. One of the machines people are hooked up to might be a heartbeat monitor (that beeping thing with the jagged line, that sends an alarm when it goes to a flat line, so stimulation to restart the heart can be tried again). Unplugging it would do nothing but remove the indicator that help is needed urgently.
Another one is blood. In older times, large loss of blood typically led to death. Now we can provide blood transfusions, to resupply.
Another one is nutrition: food and water. If a person is unconscious, they may need an IV to supply nutrients, because they can’t eat. Or there might be a feeding tube or maybe some other method I’m not thinking of. The food supply is probably put in at a point when there is a supposition of possible recovery. You don’t starve an unconscious patient; you give them nutrients, so the body can heal.
Food, rather than some “artificial life,” is the likeliest issue concerned in an advance directive. If you assume someone is not going to recover, and you want to hasten the inevitable death, you remove the food. You starve the patient to death. In the already weakened condition it could take from a few days to a couple of weeks for the unfed organs to begin to shut down, one after another.
Dying of starvation and thirst is a painful way to go. And it’s unnecessary. There are ways to continue giving the patient nutrients.
Are there exceptions? Possibly. Suppose you have an Alzheimer’s patient, nearing the end. Almost no mental function—which is soon going to affect control of various organs that require input from the brain. Suppose the patient is essentially unconscious most of the time, and never lucid when conscious. Are you required to feed artificially in order to lengthen the time of death? You could. But you could also offer food and water whenever the patient can be persuaded to swallow. At that point you are nurturing the patient, not artificially lengthening life. In this case it isn’t a matter of removing life support; it’s a matter of choosing whether to impose that form of feeding, or continuing the more natural way.
I don’t want to be a burden on my children. I intend to continue earnestly striving to maintain good health; they are all aware of this. Plus, the odds are in my favor. Brain function has been good in my family; my maternal great-grandmother had dementia in her last years. No one else. No grandparents. No aunts and uncles. My dad was 91 and fully lucid the last time I got to talk with him, the day before he passed away. My mom is 85 and still sharp and taking care of herself in her own home. So it looks like genetics are with me.
But, while I hope I can be active and involved with my family up until the very end, I recognize that some things may be beyond my control. I don’t wish that burden on my children. But I want them to know that God will bless them for any loving care they give. One way God blesses us is with increased love for those we willingly serve. So I admonish my children to willingly serve me and their dad, because I want that blessing of increased love in their lives.
I want them to know that I believe in them; they can be loving, even in difficult circumstances. I don’t discount them by thinking such a challenge is beyond them, and, like some misguided helicopter parent, signing some paper that will whisk the problem away.
I don’t mean to indict others who have “no resuscitation” orders or similar advance directives. They may have a different understanding of “pulling the plug” than I do. They may have a different relationship with God than I do. I’m not trying to persuade them; I’m just trying to declare what I want.
I want life. It’s a matter of gratitude. I want abundant life, appreciating every day I get here with those I love, even if some of those days are difficult. I want Heavenly Father to know that I hope to always trust Him to be with me during whatever hard times come. And I want my children to know that valuing life, trusting God, and offering loving service make for a better life than avoiding burdens or misplaced guilt.
I choose life.

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