Living will is gift in midst of grief
by Jane Dennis
Without warning last October, the Rev. Lamar Davis, a 73-year-old retired United Methodist pastor from Conway, Ark., suffered a massive stroke. Rushed to the hospital emergency room, he was unconscious and unable to speak for himself.
"The doctor told my daughter and me that Lamar had had a massive bleed in the brain and would never wake up," said Ann Davis, who shared 49 years of marriage with her husband. The physician then posed a critical question. "He asked what we wanted to do," she recalled.
Ann Davis was prepared with an answer, because many years ago the couple drew up living wills. "We had discussed this subject, and I knew exactly what we both believed about it," she said. "After finding the staff could keep him comfortable, with no pain, we had no problem making the decision to put him on palliative care. It was so reassuring to know that we had all discussed this possibility. We were comforted to know it is what Lamar would have chosen, could he have made the decision at that time."
Fourteen hours later, Lamar Davis passed away.
While the presence of a living will didn't ease the pain and grief that accompanies the death of a loved one, it provided a measure of peace of mind.
"When you are experiencing such a loss in your life, it is such a relief to know that the huge decision of whether or not to put a loved one on life support has already been made by the one who is dying, and you have reached that understanding together," Ann Davis said.
Today, everyone is strongly urged to discuss their end-of-life wishes with family members and to put them in writing with advance directives, such as a living will. The Terri Schiavo case — a worst-case scenario with family members battling over what the brain-damaged Florida woman would have wanted — has provided the impetus for a renewed emphasis on the importance of advance directives and living wills.
Defining the terms
Advance directives are legal documents in which individuals express their wishes about the kind of health care they want to receive should they become unable to make their own treatment decisions. There are two types of advance directives: the living will and the durable power of attorney for health care.
A living will is a legal document. It states in advance a person's desire to receive, or to withhold, any treatment that might be considered life-prolonging or that artificially extends the dying process. This is put into use if someone becomes permanently unconscious or terminally ill and unable to make decisions.
The living will applies only when two medical doctors determine that the patient is either in an irreversible coma or is suffering from a terminal illness and is unable to make decisions. As long as a patient is able to make health care decisions, the living will cannot be used.
A durable power of attorney for health care decisions designates someone, usually a spouse or child, to make decisions for you if you become incapacitated. It is important to talk to your health care proxy (sometimes called an agent or surrogate) about what you want.
The rules for making advance directives vary from state to state. Some states require two distinct forms for the living will and the power of attorney, while others combine them.
State laws also differ on rules regarding who can sign a living will as a witness and how many wit-nesses are required. It's always wise to consult an attorney to be certain you understand and meet your state's requirements.
Easing the decision
The Rev. Tim Atkins is an attorney and ordained United Methodist elder who has served as legal advisor to the Memphis Annual Conference for several years. Not only has he made available a sample living will for Tennessee on the conference Web site (www.Memphis-umc.org), he knows firsthand the importance and value of such a document: His brother Charles was diagnosed with throat cancer at age 37.
As Charles' health waned over the course of four years, the two brothers talked candidly about end-of-life decisions and treatment options. Tim Atkins was named as his brother's power of attorney.
When Charles got pneumonia and his lungs ceased to function, "we watched it for a number of days, and it became clear it was a situation that wasn't going to get better. I spoke with the doctors and exercised my powers to cut the machines off, which is what he had expressed to me as his desire and under the document I had the power to do," Atkins said.
What's important about a living will is "it allows you to make decisions about your own life prior to a time when you might not have the ability to make those decisions," Atkins said. "In most cases, even if there's not a document in place, and if all immediate family members agree, the doctors and health care providers will honor the family's wishes. But you never know.
"There have been enough court cases over the years that it's important to have that documentation. The Schiavo case is a prime example of what might happen" if there's no clearly written document or directive.
Along with prayer and a supportive family and faith community, living wills and advance directives are "important aids" to families and physicians caring for a loved one at the end of life, said the Rev. Larry Hollon, general secretary of United Methodist Communications. Hollon's 32-year-old son died four years ago when a genetic condition resulted in the impairment of vital organs.
"We had talked together about the eventuality of an incapacitating condition ... and he made his wishes very clear to us," Hollon said.
"Having dealt with that up front, in a very painful and emotional assessment, we were able to do better by him at the end stage of his life."
The decision to prepare a living will or to agree on a "do not resuscitate" order is "a very, very personal thing that each individual and each family has to decide for themselves," Hollon added. "Our experience was it was an important aid for making the best decisions for someone we loved very dearly."
-- Jane Dennis, editor of the Arkansas United Methodist, the newspaper of the Arkansas Conference.
"While we applaud medical science for efforts to prevent disease and illness and for advances in treatment that extend the meaningful life of human beings, we recognize that every mortal life will ultimately end in death. ...
"We urge that decisions faced by the dying be made with thoughtful and prayerful consideration by the parties involved, with medical, pastoral, and other appropriate counsel. We further urge that all persons discuss with their families, their physicians and their pastoral counselors, their wishes for care at the end of life and provide advance directives for such care when they are not able to make these decisions for themselves. ..."
Excerpts from "Faithful Care for Dying Persons," Paragraph 161M from The Book of Discipline of The United Methodist Church — 2004. Copyright © 2004 by The United Methodist Publishing House. Used by permission.
The General Board of Church and Society suggests these resources for discussion and study of end-of-life issues:
• "Faithful Care for Persons Suffering and Dying" is a resolution passed by the 2004 United Methodist General Conference, the denomination's top legislative body. Resolution No. 115 can be found in the 2004 Book of Resolutions or online at www.umc-gbcs.org/issues. (Click on "The Nurturing Community.")
•The National Hospice and Palliative Care Organization has brochures and state-specific information and resources for advance care planning.Order forms at firstname.lastname@example.org by calling (800) 658-8898. More details are available at www.nhpco.org.