Athens Review, Athens, Texas

August 10, 2012

Make your last gift your best gift ever

Eston Williams
Associated Press

Athens — Eston Williams is a Minister at Aley United Methodist Church. This is the first of a two part series the Rev. Williams has written. The second part will appear in Sunday’s Athens Daily Review.

I love the story of two old fellers who had grown up together, and spent many of their days at the park, playing checkers and talking about things that were important... like baseball and death. 

Baseball because they loved the game. Death because ...well that's just something old guys think about. They had played ball together in their younger days, and watched it as often as they could as grown men.  Shortie was a catcher, and Joe threw a mean fastball. 

One day they made a pact.  They promised that whoever died first would come back to tell the other if there was baseball in heaven.  Not long after they shook on the deal, Shortie died. And he kept his promise. 

The night following his departure, he showed up in his Joe's bedroom with good news and bad news. 

“The good news,” he said, “ is that there is indeed baseball in heaven.” 

“So what's the bad news?” Joe wanted to know.

“You are pitching tomorrow night!”

I like that story, because it's funny, and because these two guys were willing to do something that most of us do not want to do:  Talk about death. 

And, although nobody honestly thinks anyone is going to get out of this alive, we don't want to think about it, much less talk about it with those we love.  It's almost as if we are afraid that bringing it up with hasten our departure.

But as a pastor, avoiding the subject is not an option.  I am blessed with many opportunities to walk through the valley of the shadow with patients and their families. 

But you know what?  Funerals are not the biggest challenge.  Nope, the biggest challenge is in the intensive care unit when a family faces the awful decision to discontinue life support on a family member who has failed to, or refused to make their wishes known. 

Over and over again, I have seen unnecessary suffering caused by our unwillingness to prepare for our own deaths.

A recent experience has caused me to begin a crusade to encourage  everyone to think about how they want to be treated at the end of their days.  

A member of my church was with her 90 year-old mother at the hospital when she was admitted to the hospital the third time in three weeks. She had tried to get her mother to make her desires about end-of-life care known but her mother had refused to discuss it. 

The admitting nurse asked her the question they are now required by law to ask. 

“If your heart stops, or you stop breathing, do you want to be resuscitated?” 

The patient turned to her daughter, and said, “Just go ahead and kill me!”  She died a few days later.

So I am begging you. Don't put the people you love the most in the terrible position of having to feel like they are killing you.  Please consider all your options, talk to your family and your doctor, and put your preferences in writing.  So that when the moment comes, your family can be completely confident that they are doing exactly what you want them to do.  I can assure you, it will be a gift you are giving those you love. A gift for which they will forever be grateful.

Now I know this is not an easy thing to do.  And the more I have investigated, the more complicated I have learned it has become.  And the complications are a relatively new factor in our lives.

Until  antibiotics were invented in 1943, most older folks got sick, and died at home of what were called “natural causes.” 

In fact, pneumonia was called “the old man’s friend” because it spared the infirm elderly a long, painful death.  With the discovery of these drugs, and a host of other medical procedures, our doctors have new tools for allowing our bodies to heal. 

But these advances have brought with them many difficult issues for families to face.  So much has changed in the medical field during our lifetimes.

It blew my mind to learn that it was in 1966 that the National Academy of Science first made the recommendation that the medical community learn a new life saving procedure called Cardiopulmonary Resuscitation (CPR.) 

In 1999, Texas law began to require  hospitals to ask the patient if he or she has completed an “Advance Directive,” stating clearly how they want to be treated. But fewer than one third of us have completed this important document. 

If our grandparents had suffered an accident on the farm as children, their parents would never have been asked if they wanted to remove life support.  None of those procedures existed. 

But today, if a person is in a car wreck, and suffers brain damage that puts them into a “persistent vegetative state,” their bodies can be kept alive with breathing tubes in their lungs, and feeding tubes in the stomachs.  Their families then are forced to make the awful decision to remove life support, or to allow them to “live” what most of us would agree is no life at all. 

When the U.S. Supreme Court ruled in the Nancy Cruzan case, a national right to die was established. Nancy Cruzan was 25 years-old when her car spun out of control, and went into a ditch. The impact stopped her breathing.

She was diagnosed as being in a persistent vegetative state, and the doctors said she could live another 30 years that way.

Her parents didn’t want her to live in that state, and wanted her feeding tube removed. But the hospital refused.

The family prevailed in the lower court, but the Missouri Supreme Court reversed the lower courts ruling, saying that her father could not make that decision.

The case went all the way to the U.S. Supreme Court, and in 1990, the court upheld the Missouri Supreme Court ruling that not even the family could make legal choices for an incompetent patient.

The U.S. Supreme Court said only the person themselves can make this decision. No one else can make the decision for you. Even your guardian cannot make that decision for you. Only you, yourself, can make decisions regarding your care.

Nine years later, the Texas legislature passed The Advance Directives Act which set forth the legal language which basically gives you and me the right to refuse medical treatment under two circumstances:  1. “If in the judgment of my physician, I am suffering with a terminal condition from which I am expected to die within six months, even with available life-sustaining treatment provided in accordance with prevailing standards of medical care; and, 2. “If, in the judgment of my physician, I am suffering with an irreversible condition so that I cannot care for myself or make decisions for myself and am expected to die without life-sustaining treatment provided in accordance with prevailing standards of care.”

So we each must answer these questions:  What do you want the doctors to do, if you are “suffering with an irreversible condition, so that you cannot care for yourself or make decisions for yourself, and are expected to die without life-sustaining treatment?” 

Would you want to be kept alive as long as possible?  Or would you want to discontinue treatment, and only receive comfort care, keeping you as pain free as possible until you died a natural death?

But the standard Directive to Physicians may be insufficient to insure that your instructions are followed. 

Part two of this article will discuss a more detailed set of instructions.