The Living Will

[Christine Ann]

Another thread brought this subject to mind.  Does the Church have a policy about the Living Will?  When my husband had surgery a week ago, the forms were given to me.  Also forms for Medical Power of Attorney.  I began to read the documents.  The first thing I came across was if my loved one was in a "vegetative" state would I permit the withdrawal of intravenous sustenance  (food) and water.  This is what I understood it to say.

 I couldn't help but think about the young woman to whom this was done who eventually died and the controversy over that decision. I'm sure someone will remember her name, it won't come to me.

I laid the forms aside, knowing I could never deny him life under such circumstances. I didn't read any further and we decided to go forward without a Living Will or Power of Attorney.  I've never been in this situation before in my life, and I need to know if the responsible thing to do is have these documents completed.  I felt uneasy especially not having the Power of Attorney. 

 If these circumstances ever come up again,  I don't want a doctor to make such an important decision. Should Lloyd have had these documents prior to what was a serious surgery?  If no one is named, then who makes the call for life or not?
 
I didn't have time to ask an attorney, so he had the surgery (which went very well) with my not knowing what could happen.  I don't want to have this situation again for either Lloyd or me. 

What is the Church's position on these documents?  Is there a Catholic form to be used?  If so, I would like to implement it.

In Christ Jesus,
Christine Ann
 

[David W. Emery]

The first thing I came across was if my loved one was in a "vegetative" state would I permit the withdrawal of intravenous sustenance (food) and water. This is what I understood it to say.

You understood this correctly, Christine, and this is where the Catholic Church parts ways with the prevailing secular wisdom. I have always refused a living will based on this provision, which no seriously moral person could accept, for it is tantamount to murder.

That said, the Church does not oppose the concept of a living will provided that it is set up in a morally acceptable manner.

A power of attorney is most helpful when a loved one is incapacitated. I have a power of attorney for my long term disabled wife through a legal guardianship. The guardianship has many times proved its worth, in spite of the legal costs and the bond requirement. It’s something I would not be without. A simple power of attorney could save your spouse’s life by allowing you to intervene instead of taking pot luck with the attending doctors’ and nurses’ ethics.

David

[left coast mystic]

I am a financial planner by profession and I want to clarify something about living wills.  These are forms in which you can make it clear exactly how you want to be treated in the event of being in a vegetative state or similar condition.  If you want to make it absolutely clear to everyone that you WANT life-sustaining treatment, it's VERY IMPORTANT to complete and sign a living will in which you have marked the boxes that show your preference for that approach.  If you DON'T have a living will and someone in your family (or depending on what state you live in) perhaps even a doctor, decides that it would be "best" to simply let you die, there's no record to prove that you have not authorized that approach.

In some states, such as California, these types of forms are called Health Care Directives, or sometimes Durable Power of Attorney for Health Care.  The purpose is the same for all - to enable people to make it ABSOLUTELY CLEAR how they want to be treated when they are not able to speak for themselves.  California's forms also have a section where you can make clear what your wishes are about donation of organs and other issues after your death.  Again, if you don't have a written record of what you want, everyone is left to simply guess and ultimately make the decision for you. 

Once you've filled out one of these forms, keep a copy at home (and tell your family members where it is) and give a copy to any and all of your doctors.

Bottom line, EVERYONE should have a living will - just make sure that you've marked it to show that you want all possible means of life supporting treatment.


Marcee

[Christine Ann]

David, I understand your concern.  When I saw that first question I thought, "I want no part of this."  It wasn't just a yes or no question, there was just blank space for a reply. 

But I understand, Marcee that the medical power of attorney would have made for a safer situation.  I know what my husband's desire would be, and  that I be the person who makes those decisions and vice versa. 

I'll get the forms from our attorney and look at them more thoroughly.  I have to admit we should have something stating our wishes.  I just had so short a time to look at them, and I was so shocked at the first question.

Thanks for your input, Marcee.  I always heard that one should have a Living Will and I think it's time we explore the issue further.  Next time we have this come up, I want to have a copy of his wishes in my hand when we enter the hospital and I would want that for him.  I'll read it very carefully and be explicit about our wishes.  Thanks again to both...

Christine Ann

[Steven Barrett]

Maybe it's me, or the way I tend to look at things through a legal eye perhaps more than I should at times, but I find it odd that sometimes I'll hear my wife practically shudder when the subject of wills, "who goes first" in the case of simultaneous deaths, things like that. To me, it's no problem since I'm also a certified paralegal. In the case of a "tie" (as in car crash, on paper, the husband "goes first," and for tax and estate reasons only. Blame it on the "romance" part of marriage, where the "perish the thought" mindset takes over and we forget that each marriage, as the rubrics in our wedding ceremonies are supposed to plant in us is indeed an estate, a little state, nation, country, or kingdom unto its ownself. Nobody likes to face our camelot's "end times," but we have our heirs to consider if we want to leave a nice reputation and some $ they'll appreciate. That requires doing the necessarily sad homework. But once it's done, it's done and you go on LIVING.

I’d like to get my hands on the guy who came up with the line, “A man’s home is his castle.” In the real world we know it’s not often like that. I’ve seen tons of books sold in “Christian Bookstores” and “Men’s Conferences” promoting such idyllic fantasies. But the guys writing those tomes of husbandly wisdom are all pretty well off and don’t have to worry about mistakes in signing off on living wills in case an “oops” or something else happens. Their wives are already taken care of, esp. if they’re megachurch preachers who’ve managed to set their wives up on the church’s payroll (with the title of “First Lady”) as well. There are only two First Ladies I have to answer to, Mary and Ruth; sorry Michelle.

Besides any married man with two working brain cells that are still talking to each other, will have to admit this one fact of life very few priests will pass on during Pre-Cana and most fathers are only too eager to let their sons and sons-in-law learn the hard way – but DON’T. Guys, we know we’re the kings; but we also know who the Prime Minister is. Who has the keys to the nukes? That’s right. You’re learning fast. And once you have kids, it’s always “Question night” … and not for the PM, but for the sovereign. And make sure you get a better living will than the one Charles I or Louis XVI and Marie Antoinette had. 

[Ruan]

Hmmm.

I just buried my mother on Mar. 2. She was almost 99. I learned a lot watching her decline and death. She had a heart attack and stroke on Jan. 20. but survived. In the hospital, the attitude is to "save" a person's life with aggressive treatment. My mother had excellent doctors who recognized that in her case this "aggressive" treatment might not be appropriate - causing her untold discomfort and pain. Esp. a pacemaker, which has to be turned off by the doctor when death has come in every other way, all other organs and the brain having shut down. So it was decided amongst us siblings, at doctor's recommendations, to put her in hospice care. She stabilized there so she was taken to the nursing home where she was still under hospice care. She died Feb. 24.

During all that time, I watched her slowly decline. At first she begged for water which she could have only in a thickened form so that she wouldn't choke due to the effets of the stroke on her swallowing. Before all this she had pretty bad dementia anyway so her memory and cognitive skills were impaired. It was hard for her to understand why she couldn't have liquid water. She ate only pureed foods but only 2 bites at any meal. All she wanted to do was sleep. Eventually she didn't want to drink but a sip or two. It actually seemed cruel to force her to dress and sit up, which she didn't have the strength for. But the attitude of medical caretakers (in the nursing home) is always to stimulate, to do everything to get the person well again. In hospice, this is not the attitude to take. Comfort in whatever form is the approach. I watched my brother (an MD) struggle with the decision to want to give her IV hydration, he thought to make her comfortable. It would not have made her comfortable. She would have become swollen with the fluid which her kidneys could no longer process. (I saw this with my Dad when he died.) Finally she died in her sleep, dieing within the 3 months which the cardiologist predicted.

Hospice was wonderful. They gave us some very informative brochures about the dieing process and experience  that everyone should read, esp. before signing living wills. There is a lot more to dieing than we could ever imagine. So for me, a Power of Attorney for Heatlh Care is what is most important, so that caring family members can make the decision as the moment arises. It is so hard to predict what might happen at a person's death. How can you decide you want all life suppport treatment when your body might be trying to shut down? It then becomes cruel treatment. Best to leave those decisions to those you love. More important to inform those people about the dieing process so they can make informed decisions for you.

Just my 2 cents.

Ruthie

[Intercessor]

Ruthie, may the soul of your mother rest in peace.

I agree with you that it is very sad when relatives or medical staff refuse to let a person die in peace.  So many families push food on a dying person who is nauseous, has no appetite, whose system is shutting down just as it is supposed to do in the dying process.  

Fretful nagging and pushing spoons at the lips are about as appropriate at this point as they would be if the individual were deep in prayer before the Blessed Sacrament.  Perhaps the folks who do these things have failed to make their own peace with death; perhaps they allow their own fears and self-centered desires to trouble the poor person who wants only to rest, sleep, reflect, pray, and prepare for death.

St. Joseph, grant us a good death without persons poking spoons at our lips and nagging us to "take one more bite."

Grace and peace,

Becky

[Steven Barrett]

I'll never forget watching my mother die of liver cancer. It was awful the last month. Yet, while my brothers were more shaken up on the inside, particularly m middle brother who was very close to her, don't ask me how, but for some reason while watching her die and saying the Rosary over and over, she gave me strength (of faith) wheras my brothers and esp. (understandably our dad after 43 years of marriage) were emotionally knocked flat on their backs. It was worse when they saw the effects of morphine during he past few days and she was totally not herself, saying things if we said ... well, none of us would've been alive ... but all (retrospective) kidding aside, the  part that emotionally almost did in our father was when she demanded to go home and we knew it was only a matter of days. Oddly enough, she had enough presence of mind (despite the morphine) that when my wife brought our only son at the time, she was her old self and in full control, holding Jimmy on her lap, demanding water for him and giving me The Stare when I didn't catch on at first. Fortunately, she made arrangements for non-heroic measures and still died with dignity. Whatever anyone does, when the dying patient wants to go home after taking morphine, do NOT make a move unless you can't avoid it. She did NOT want my dad living with that and that probably saved his life that year. He died four years to the same (albeit moveable) Feast Day of the Ascension. Hmmmm.

[Ruan]

Thank you Becky for your kind words concerning my mother.

It sounds like you know exactly what I'm talking about.

And how do you relate that with signing a living will?

Steve, I'm sorry you had to go through such a difficult time watching your mother die of cancer. Do you think the morphine was a bad thing? My mother had morphine too, to help her through the anxious, agitated, disoriented times. It worked well for that, relieving the mental and emotional torment she was going through at times.

So how do you relate your experience with signing a living will?

Another document to consider is a Do Not Resuscitate form. Maybe that is for elderly people (what age is elderly?). I have heard of horror stories of attempts to resuscitate people no matter what when there is not a Do Not Resuscitate form.

It seems there are two approaches here - helping the physically afflicted to stay alive using extraordinary measures or allowing the dyeing person to die a natural dignified death without using extraordinary measures. When signing a living will, how can we predict which case ours will be? I guess that's where the Durable Power of Attorney for Health Care comes in. Well, no Living Will for me, just the Power of Attorney. And as I get older, perhaps a Do Not Resuscitate form.

[Intercessor]

Thank you Becky for your kind words concerning my mother.

It sounds like you know exactly what I'm talking about.

And how do you relate that with signing a living will?

It seems there are two approaches here - helping the physically afflicted to stay alive using extraordinary measures or allowing the dying person to die a natural dignified death without using extraordinary measures. When signing a living will, how can we predict which case ours will be? I guess that's where the Durable Power of Attorney for Health Care comes in. Well, no Living Will for me, just the Power of Attorney. And as I get older, perhaps a Do Not Resuscitate form.

Ruthie, I agree that the proper state forms for authorizing a specific person (and a contingency, should the first become unavailable) to make medical decisions on one's behalf is the best choice for me.  I have also informed all my relatives and close friends that decisions made about my care should be in alignment with the teachings of the Catholic Church.

Becky

[Steven Barrett]

A little backtracking "clarification" here. While mentioning above about having only two "First Ladies" to, i.e. Mary and Ruth, to answer to in a reference to a trend with in Evangelical Protestant congregations--most often the more  "supersized" megachurches--the Ruth I referred to was my wife 27 years.

Sorry for any confusion! 
S.

[Truthseeker]

hI all-
It's been a while.  I am still being treated with chemo for my breast cancer in my lungs.  My tumors have not shrunk, but have not grown, either.  My doctor has informed me that most people live an average of 7-9 years once they get cancer in their lungs.  I realize this could be longer (or shorter), but also realize that I need to prepare for disablement and death (because even 10 years passes quickly), so this has really been on my mind, lately.  I tell my husband to do whatever Father Steve (my confessor) says to do.  Father Steve is one of my emergency contacts.
But, I've wondered - It's one thing to ask that food and water not be removed, but do I have to get them in the first place?  And, if I'm pretty much dying (or bodily dead), can I remove breathing tubes, so long as I'm not removing food and water, since breathing tubes aren't "natural" like nutrition is?  Would a priest help you fill your directive out?
*And hi and love to everyone!
Laura

[Ruan]

Laura, I'm so sorry to hear of your condition!

I just want to comment on your questions. I'm not a professional of any kind to do with end-of-life issues. But I just learned quite a bit from my mother's decline and death in January and February.

I hate to be so blunt about these things. But in your situation, if you finally come to a point where your doctor deems your case as terminal, he will point you toward receiving hospice care if you are within 6 months of death, in his estimation. In hospice, you don't have to address these issues about feeding tubes and such. Hospice care consists of keeping the patient comfortable so you can die a natural and dignified death without extraordinary or aggressive treatments.

Hospice caregivers are so wonderful and can explain the position of hospice. I received brochures on the dying process which were so helpful and I learned so much. When a patient is dying, they will actually in many cases start to withdraw physicallly as well as mentally and emotionally. They can stop eating and drinking or eat and drink very little. They have no appetite. To force feed such a person is actually a cruel and uncomfortable treatment. Their bodies become beyond being able to process food and liquid. In hospice, they do not use such procedures. They actually have to get the doctor's permission to use such treatments. It's a whole different approach - one of helping the patient to die comfortably rather than to aggressively treat a condition so as to help you live, which is what they would do in the hospital as opposed to hospice. The important part is to transfer to hospice at the appropriate time.

For myself, I would opt only for a Power of Attorney for Health Care - someone who can speak for you when decisions have to be made.

I hope I haven't offended you, and I hope that you have a long life yet ahead of you. Perhaps someone else more knowledgable than I can offer some information as well. Did you read all the above posts?

It's good to see you back on the forum Laura. you sure have had your share of heartaches. May God bless you.

Ruthie

[Truthseeker]

Thank you Ruthie-
Firstly, I'm never offended by blunt but compassionate info.  Secindly, I appreciate the infi you gave me.
I will not be able to be treated in hospice, as my state insurance doesn't cover it.  I am trying to figure out how to make it all the least damaging to my family.  Do I just linger at home until they all watch me slowly die, or do I live at the hospital, where they will have to visit me to watch me die?  I'm guessing home, but I've got time to figure that out later. 
I have summers off from work, so I have decided that all big issues can wait until then - such as getting rid of all old stuff, so they don't have to goe through so much later, and issues such as this, and planning my funeral.
It's all scary, but not as scary as wondering and no one answering my questions - so yeah, blunt is good with me.
Blessings,
Laura
And, I'm sorry about your mom.  I hope all your family is healing.

[David W. Emery]

Hi Laura,

The point of end-of-life decisions, such as hospice or power of attorney or a living will, is to make you as comfortable as possible, not to “get it over with.” You are in an especially advantageous position; the disease has known characteristics, and you can plan your approach around that. So the question comes down to: Where would you be most comfortable? Whom would you prefer to make the decisions as they are required, should you be unable to do so personally at that time? As I see it, the thing to do is to get the paperwork done now and rest easy, letting God make his decisions in his own time. Whether he gives you one year or ten, you are prepared and can be at peace.

David