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Advance conversations help when applying advance directives

By Mike Miller  ·  Jul 05, 2012

Even if power of attorney is set up, it is still best to know the patient’s wishes

Part 2 of a series

Designating a durable power of attorney for health care decisions is easy enough if you have the money and the legal help.

But being the person who is the health care power of attorney can be anything but easy. You may be making key decisions that will mean the difference between life and death for someone close to you who can’t speak for themselves.

And you need to do it in a Biblical way. Since we are created in God’s image (Genesis 1:27), all decisions about life can have eternal ramifications. This is not just true in the case of our life’s beginning, but in the case of the end of our life as well.

That’s why, Christian physician Jack Bicket says, it’s vital to have a conversation among family members—especially involving the person with power of attorney—so it’s clear what a patient’s desires are if a life-or-death decision is to be made. Decisions like whether to

  • Remove a respirator.
  • Have a risky surgery performed.
  • Remove feeding tubes.
  • Put tubes in to begin with.

“You cannot imagine all the different scenarios that might occur, but you know the patient, you understand their values,” says the North Carolina physician and member of the Christian Medical and Dental Associations. “Although you may not know exactly what they would want to do in every situation, you’ve had conversation enough so that you feel comfortable making that decision.”

You stand a good chance of having to make that decision, even if you haven’t had the conversation or aren’t a health care power of attorney.

“If someone doesn’t have health care power of attorney or a living will, doctors are still going to come to you, the family, and say, ‘Here’s the situation we have with your mom, your dad, your grandfather, whoever it might be, and this is our recommendation: That we should take them to surgery to try to repair that bowel obstruction,’ for example,” Bicket says.

“Now, for your dad or grandfather, that might carry significant risks because he’s 83 or 100 years old, he had lung disease and heart disease, and this surgery is risky and so on. They’re still going to come to the family.”

Advances in technology can help with decisions—or complicate them. For instance, you may have expressed your desire not to be kept on a respirator and wake up one morning having trouble breathing. However, there’s a chance doctors could find out what’s causing the problem, so they’ll want to check it out: Is this due to a worsening lung problem, or is it due to a heart condition which could be helped?

“So we’re going to put you on the ventilator to keep you alive right now, but then we find out down the road that you deteriorate and basically you have a major stroke while you’re on the ventilator or a major heart attack, and it becomes clear that you’re not going to survive this,” Bicket says. “At some point, the family could decide to take you off the ventilator. If they take you off the ventilator, then you’re going to die.

“At some point, you reach the point where you realize that you’re overmatched by your disease or condition.”

If the decision is made to remove the patient from the ventilator, family members need to know that they didn’t kill the person; rather, the disease killed him, Bicket says.

“By far, the hardest decisions for people to make is when to quit,” the doctor says. “It gets to be sometimes a challenge for those of faith in that they think that we should continue to do everything possible to preserve life to the very end—even if those things that we do come with significant burdens and with very little expectation of success.”

The Christian physician says that while death is our enemy, “at the same time, it’s a defeated enemy.”

“Christ has defeated death in the end,” he says. “We are going to be resurrected. We’re going to live forever. So while we’re in this life, we ought to fight death, we ought to avoid death, but somewhere along our lives, the time will come when it’s probably better that we rest in Christ than we fight what’s going to take our life. And it’s that decision that is hard for patients and patients’ families to make.

“We all know that we’re going to die unless Christ comes back before that. We’re all going to—at some point—pass on. That’s the way God has set up our world, is that we’re going to die. We don’t need to be there any sooner than we’re supposed to be. At the same time, I do think that the easy position for people to be in is that, ‘Well, I don’t know, but I feel most comfortable just doing whatever I can to keep the patient alive.’

“That, I don’t think, is necessarily God-honoring, either.”

However, Bicket admits, “Where that line is gets to be difficult. It’s hard to quit on them.”

“When I was a resident 20 years ago, we kept doing things and doing things for patients, even if the patient’s family objected,” he says. “We were focused on caring for the patient, and we hadn’t heard from them, so we would just keep going. That was a mistake to have that approach. Now we have to be careful that we don’t swing the pendulum too far to the other side, where you say, ‘Well, they’re 83 years old and they have kidney failure, and they’ve got a little Alzheimer’s going on, and it’s a burden for society and the patient’s family, maybe we ought to just let this patient go.’

“I think the more I see of it, the more I realize that you have to give everybody in their own decision-making some grace, because it’s just not clear cut. To some extent, these decisions are made with the respect for God’s appointed role in the world, which seems more acute in those situations than it is in our daily lives.

“I think it’s one of the reasons that our lives should be ones of integrity, that this is a daily walk with Him so that when the tough decisions come by, we can make them with some sense of peace.”

Next: When it serves God to endure.

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