Difficult Seasons

Many difficult decision situations that arise in caregiving can be can be easier to handle if you and your loved ones do some advanced preparation.  Ideally, many of these should be done even before you become a caregiver, but if they haven’t been, there’s no time better than the present.

There are basically three kinds of advance medical directives:

1.  A Living Will specifies what kind of medical treatments are desired should the individual become incapacitated.  Living Wills nearly always contain the statement:

If I suffer an incurable, irreversible illness, disease, or condition and my attending physician determines that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.

Other more specific statements about treatment options can be included as well.

2.  A Health Care Proxy is a legal document in which an individual designates another person to make health care decisions if he or she is rendered incapable of making their wishes known.  The designated individual has the same rights in making a decision as the person would if they were able to make their wishes known.

3.  A Durable Power of Attorney provides the power of attorney to others in the case of an incapacitating medical condition. The durable power of attorney allows an individual to make bank transactions, sign Social Security checks, apply for disability, or simply write checks to pay the utility bill while an individual is medically incapacitated.

Since these and similar documents are legal documents, they must be signed and witnessed, and you might want to consult an attorney to have them drawn up in accordance with the laws of your state.

These documents, and the discussion that you may have with your loved ones while preparing them, can go a long way in making decisions during crisis times easier to handle.  You know ahead of time what the individual would like to have happen, and you have the right to make the decision.

There is one big caveat, however.  These documents are of no value unless the physicians and hospitals know about them. So it’s important to have copies in a readily available place in case they’re needed.

A big Aha! occurred to me yesterday during one of my visits with a hospital patient.

I had been visiting for quite a while with a woman, recently diagnosed with an aggressive type of cancer, and with her husband.  We had talked a little about the disease, but part of what was going on was that they hadn’t received a final diagnosis and treatment plan from the doctors yet, so there was anxiety about that.  And of course they were both still in shock that this was happening to them.

It was interesting that during the conversation, I’d ask the wife a question to give her the opportunity to talk about how she was doing with all of this, and before she could get started good, her husband would jump in and divert the conversation.  I could tell that she wanted to be able to tell me, and I could also tell that her husband didn’t want to see the pain that she might express — the purpose of his interruption.  So we talked lightheartedly about what was going on.  And he kept doing the same thing.

So as our visit reached the time for prayer, I looked to the woman, and saying her name, asked, “I want to know what you would like to pray about.”  And then I made eye contact with her husband to make sure he understood, and he did.  And here’s where the aha! came in:  when she hesitated a moment, I asked, “What is the one thing that is your biggest concern right now, the one thing we can pray about?”

Immediately, and with a voice full of emotion, she said, “Being able to deal with whatever comes.”

She had just named her biggest fear, the thing that she was struggling with most at that moment.  And the emotion in her voice told her husband and me how important that fear was, and how important it was to her to be able to say it out loud.

So that fear was what we prayed about, thanking God for His presence, and asking His help in dealing with whatever comes.

It’s a great privilege to pray with someone, and I want to do it in a way that honors both God and the person I’m praying with.  So I made a mental note to ask more often about the one thing people would like to pray about, the big thing they’re struggling with at that moment.  Praying specifically about the one big thing may be more meaningful for someone than praying about several more general needs and desires.

While visiting with a man yesterday who was in the process of dying, he asked me to pray with him and his family who had gathered to support him.  So as has become my practice, I looked him in the eyes and asked him what he’d like to pray about.

What he said was something like, “Pray that like Abraham, I’ll find a path.”  As I grasped the word picture he was painting for me and his family, I immediately heard the words my mom spoke to me years ago as she knew she was dying.  “I’m not afraid of dying, of what’s on the other side.  I’m just afraid of the process of dying.”

This minister of 40 years was helping us understand that he was on a journey into a foreign land, like Abraham, and that he didn’t know the way, but that he was wanting and trusting God to take his hand and lead him to his destination, the promised land.

Everyone fears the process of dying.  Even Jesus had anxiety about the process as he spent the night before his death in the Garden praying about it.  So it’s okay if we’re anxious, if we’re fearful.

Like Jesus, we pray about our anxiety, our fears.  And like this good man, we pray that God leads us through this unknown territory, showing us the way.

In the sidebar under my photo, you’ll notice that I’ve published an e book on Making Hospital Visits.  It’s a collection of some of the things I’ve written about my experience in visiting hospital patients, an I’ve published it in hopes that it will be useful both to those who are experienced in making visits and also for those who have little or no experience.

It’s easy and free to download.  Just clicking on the link will open the e book as a pdf file, and then you can choose to save a copy from the menu and/or print a copy if you prefer.

I hope it blesses you in this important outreach to people in need.

And by the way, I’d appreciate any suggestions for improving the content or adding material to help you with things that have not been covered.

What situations or conditions could mean that a person is no longer able to make decisions about his own welfare?

In the previous post, we talked about some situations where as a caregiver we might not like or agree with a decision, but that the person still had the right to make it.  To repeat, just because we don’t like or don’t agree with or even recognize that the decision our loved one is making will result in more risk or a reduced life span doesn’t mean that we get to override it.

Our society has processes of law that govern when this may happen.   Law provides that the next of kin or someone having power of attorney can make decisions for the person if she is medically incapable of making the decision herself.  Examples of when this might apply are when a person is in a coma or when a person is suffering from advanced dementia or certain mental illnesses.  The medical community has stringent guidelines governing this process, and ethics groups to help advise in difficult situations.

If the person does not or has not given this right voluntarily, and a qualifying medical condition to allow someone else to make decisions for them does not exist, then a judicial process in which proof of the person’s incompetence to make decisions is required, and the burden of proof is high.

We place a high value on the right of an individual to make their own decisions.

If you end up in one of these situations, seek the counsel and advice of the physicians involved and ask to visit with a social worker, who has training and resources to help you plan a course of action.

These are definitely difficult times.  In the next post, we’ll talk about some things you might be able to do in advance to make difficult decisions somewhat easier.