Most of us want autonomy and freedom of choice in our lives, but when it comes to decisions about one of the most important events of our lives — our own deaths — we sometimes leave those to others. End-of-life decisions are not easy to think about, but they are important topics to consider and discuss with family members, religious leaders or healthcare professionals.
With proper planning, people can make sure their wishes are known and followed, and families can avoid unwanted and expensive care. There are many ways to begin the conversation to make sure when you die that your wishes about how you want to be treated are taken into consideration.
By making your end-of-life decisions now, there will be comfort for you and your family. Critical care choices will have been prearranged and loved ones will have a guide to follow.
Make sure this doesn’t happen to you
What will happen when it is time for someone to make an end-of-life decision about you if you cannot make your own wishes known?
A November 2017 letter to the editor of the New England Journal of Medicine’s editor raised that question and still attracts attention — particularly from the perspective of life-and-death personnel (physicians, nurses, lawyers, health providers and religious leaders). It’s worth sharing.
Dr. Gregory E. Holt and his colleagues wrote about a patient who did not want to be resuscitated. At least, that was a good assumption, as he had “DNR” (medical term for ‘do not resuscitate’) in the form of a permanent tattoo on his chest.
Sadly, according to the article, paramedics transported the gentleman into the emergency room in an unconscious state. The Journal’s letter states his personal “advance directive” was unknown.
The “patient’s tattooed DNR request produced more confusion than clarity,” given concerns about the tattoo’s legality, said the letter’s authors. Although the authors state they “neither support nor oppose” the use of tattoos to express end-of-life requests, there are better ways.
Final wishes: living wills, advance directives and the POLST
To receive the kind of care you request at your life’s end requires an advance directive. According to the Mayo Clinic, “Living wills and other advance directives are written, legal instructions regarding your preferences for medical care — if you are unable to make [those] decisions yourself.”
Living Wills advise your medical team about life support. A living will is actually a type of advance directive. Advance directives provide an explicit guide for end-of-life care. Directives “aren’t just for older adults,” says Mayo Clinic on their website. “Unexpected end-of-life situations can happen at any age…”.
Today, some lawyers and physicians also advocate for a Physicians Order for Life-Sustaining Treatment, known as a POLST.
The POLST was originally developed for frail, chronically ill and institutionalized persons. It wasbased solely on the patient’s advance directive — to aid paramedics and other medical providers, as well as family members — by stating precisely how they wanted their end-of-life care, according to Hurley Elder Care.
But the POLST “does not replace an advance directive. It is a legal document in Georgia that serves as an addition to your directive in the form of a physician’s order.
Medicare & Medicaid coverage
“In years past, physicians did not always discuss a patient’s health status with the patient or the family,” said Dr. Adrienne Mims. She serves as vice president and chief medical officer for Alliant Health Solutions.
“With the growing population of aging adults, and death not being optional, more physicians need to become comfortable in having these needed discussions. The good news is the Center for Medicare & Medicaid Services recognizes the importance of having these conversations and [since 2016] pays physicians to have these discussions with their patients.”
Finding help for end-of-life decisions
“The intersection of religion and end-of-life decision-making is intrinsically linked, yet end-of-life discussions can be in conflict with religious values and beliefs,” said attorney Barbara Rogers with Arnall Golden Gregory, an Atlanta law firm. “It is incumbent upon the community, including religious leaders in connection with healthcare providers, to think and plan for the inevitable.”
A physician and a rabbi
“Rabbis who attend hospitals and guide patients and families through their spiritual journey should be very well informed on end-of-life’ decisions,” said Rabbi Analia Bortz, who is also a medical doctor.
“In our pastoral care, we might be good advisors on how to navigate the system and address families in sensitive matters,” she said. “As a rabbi and a physician, I feel responsible for being present at the bedside, to provide a good ear to listen and help people feel that they have been heard.”
A Lutheran reverend
Reverend Kevin Martin of Prince of Peace Lutheran Church in Johns Creek spoke about religion and death at Emory Johns Creek Hospital last year. He said “Having something familiar to fall back on when there is an awkward moment at the end of life may become a cherished time.”
During a panel discussion, Martin shared how Sam Keen, a former contributing editor to “Psychology Today,” had interviewed a patient, author Earnest Becker. Becker wrote “Denial of Death,” which won a 1974 Pulitzer Prize.
Keen knew [then] that Becker would most likely pass before the two would meet again. As he was leaving Becker’s room, Becker reached over and poured some medicinal sherry (standard care back then) into paper cups. The two drank a toast together, shook hands and said their goodbyes.
“Whether it’s a unique custom to say goodbye, or a particular game to play, or series of questions to ask, such rituals serve as the shallow end of the pool,” Martin said. “It’s a chance to wade into deeper conversations, or a chance to come out of a difficult time without undue haste or uncertainty.”
The Muslim faith
, co-founder of the Interfaith Speakers Network of Atlanta said, “We experience grief, pain and mourning [as] humans before being Muslim, Christian or Jewish. Any pastoral care provided needs to stem from this realization. The emotions evoked by the event of terminal illness and the departure of loved ones are universal.”
From her Islamic perspective, Abbaday said that death is not seen as a “termination of life, but rather as a transition to the eternal life.”
A sacred experience for the Hindu faith
Indian-born Ameeta Jadav said she suspects that “people of Indian descent see the end of life as a passage. Devout Hindu Indians may deal with death through many special rituals including Hindu priests,” she said.
Jadav shared her personal experience of the passing of her mother, as a sacred and spiritual experience. “No religious rites were performed, but friends and family did read from the [Hindu] scriptures. That was a very soothing process.”
Lead sunset photo courtesy of Pixabay.