Each of us should decide what type of medical care we would want, once we reach a “terminal state.” Here are some suggestions for specifying our wishes.
A special example of Advance Directives (AD) for end-of-life care is a document concerning the withholding or withdrawing of life support systems. A typical declaration begins with the person’s name, followed by a request such as the following: “If my medical condition is deemed ‘terminal’ [optional addition: or I am determined to be permanently unconscious (e.g., in ‘deep coma’ or ‘persistent vegetative state’)], I be allowed to die and not be kept alive through life support systems.”
This will be followed by a list of protocols that might be initiated, depending on the patient’s medical condition. It could include such measures as endotracheal intubation (insertion of a breathing tube), ventilation (use of a respirator to aid breathing), kidney or peritoneal dialysis, enteral nutrition (insertion of a feeding tube), radiation and chemotherapy, blood transfusions, and antibiotics. The person may indicate if such measures are ‘wanted,’ ‘not wanted,’ or ‘to be tried and stopped if there is no improvement.’ One may also choose ‘palliative care,’ which seeks less to cure than to alleviate pain and distress, both mental and physical. Finally, the form asks whether the person authorizes organ donation, and provides for the appointing of a health care agent with durable power of attorney. (These and other elements can, of course, be written up in letter form and signed by the person concerned; no formal document is needed.)
Any AD should include a request for the person in a terminal state to receive the ministrations of an appropriate clergy person. For Orthodox Christians, to the degree they are conscious and capable, it should also specify the desire that they receive confession and eucharistic communion.
This signed document must then be witnessed (and possibly notarized) by at least two persons who are unrelated to the signer of the AD, who have no financial or other responsibility for the signer’s health care, and who will not benefit financially (through inheritance, life-insurance, etc.) from the signer’s death. Since States vary in the conditions they set for ADs, including the selection of Agents, it is important to check with the local Health Department, and possibly with a lawyer, for clarification.
[A good example of an AD, which can be modified as one wishes, is provided by The Center for Bioethics and Human Dignity (http://www.cbhd.org) 2065 Half Day Road, Bannockburn, IL 60015, Phone: 847-317-8180, Email: .(JavaScript must be enabled to view this email address). It is reproduced below. A useful overview of ADs, together with a declaration of desire for natural death and forms for appointing a health-care proxy can be found at the following link: http://www.state.sc.us/dmh/804-97.htm. ]
Before signing an AD, it is important that we speak, in depth, with persons who can help us make appropriate choices concerning our end-of-life care. This would include first of all our spiritual father or other trusted member of the Body of Christ, who knows us and can guide us toward a truly “Christian ending to our life.” Others to consult would include our physician and family members, particularly those who are dependent on us, financially or otherwise.
Advance Directives serve chiefly to guard our personal welfare against invasive medical procedures that represent more of a burden than a benefit at the terminal stage of our life. An Agent with durable power of attorney can represent our interests before the medical team (and, if need be, before the courts) when we become “incompetent” and can no longer speak for ourselves. The choice of such an Agent is crucial. What is required is not only an ombudsman. It is above all a friend and companion, a trusted brother or sister in Christ, who will accompany us faithfully and lovingly along the difficult pathway that leads through “the valley of the shadow of death” and into the radiant Light of the Kingdom of God.