Introduction To Directives

An introduction to directives involves understanding their simplicity and value. They are authorizations to act in a specific way. Advanced directives refer to future authorizations. They’re important at the end of our life because there are many instances when we can’t answer for ourselves. In other words, we need others to act on our behalf or perform only those actions we’ve approved.

On a swanky restaurant patio in Nashville on Broadway with Tracey Lawrence’s Time Marches On wafting from a honkytonk, I asked a science buddy if he’d really like to live forever? “Doesn’t everyone?” He was surprised I’d even ask the question. His opinion didn’t change if his eternal life was confronted with physical, cognitive, family, or financial challenges. “I take life over death in all cases.”

Advance Directives Deal With Life & Death Issues

I was certainly under the opinion that most people would want to live as long as they had their faculties and health. But that is a gift of youth; not one bestowed on advanced old age. Turns out, that people don’t always care. Research shows that we (seniors) want to live, almost regardless of our condition. We only want to hasten death when we literally feel as if we’re being permanently tortured and imprisoned. (See our Section on The Will To Live – Life Force here). I add permanently and use “and” because people are willing to bear temporary situations.

The desire to live is so great that close to 80% of people who can get to hospitals die in hospitals. This is despite almost 100% of people saying they want to die at home. Think about that for a moment. Spending one’s last days in a place you hate seems terrible. But your desire to stay alive outweighs those concerns.

This life force or desire for survivability makes sense from an evolutionary perspective. Keep the species alive and all that. But is there anything more? Most religious beliefs acknowledge aging and death as a natural state. A cycle that takes its course. A cycle so important that consciousness with pain is preferable at the end than unconsciousness.

The reason for this that religious leaders give is that God wants you to know what’s happening. God is there for you and if you’re unconscious, you’re not there for God. It’s a kind of denial of God and God’s love for you. But you can seek out religious experts in your belief to become educated in what your religion expects of you in the dying process.

Without Good Advance Directives, We Often Die Where Others Choose

Senior hospital-based deaths often happen because others make your decisions at the end of your life. Others usually don’t feel comfortable with you dying at home. Or they find it easier to place you in an institution (i.e., it’s easier for others to manage you when you’re in a hospital or institution). Regardless, if you don;lt tell people what you want, and do it with the proper “authorizations” you may not get what you want. It wasn;t until after an introduction to directives that I learned how you can avoid outcomes you don’t want.

America Has Defined Sovereignty Similar To A Bodies Autonomy

There is another area that sheds some life on the importance of dealing with medical interventions to prolong life and it’s uniquely American. The American experiment requires that we pay attention to this aspect of our life. Prior to the founding of America, God and Sovereign battled it out for how people should behave. You either listened to God, your Sovereign, or some combination. Americans changed that.

In our Declaration of Independence, we agreed, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” When “we the people” created a constitution, “we” attempted to obliviate the possibility of a King or recognizing that a human sovereign had the right to make rules for other humans.

The founding of America gave individuals control over their government. If individuals had control over the government, an individual needed inalienable rights. If individuals have inalienable rights, they’re free, autonomous, and able to make their own decisions. As part of an introduction to directives, it’s important to point out how much power we have over our own bodies.

As abstract as this statement is the Older American’s Act (OAA) and their successor, the ACL states, “Every [senior] should have the right to make choices and to control the decisions in and about their lives. This right to self-determination includes decisions about their homes and work, as well as all the other daily choices.”

The Constitution Makes Seniors Responsible For Their EOLCs

We also, via the Constitution, tried to “de-sect” or secularize religion in the sense that the Government could “make no law respecting an establishment of religion, or prohibiting the free exercise thereof.” It placed the practice of religion in the hands of the people. The Establishment Clause made anyone’s religious belief subordinate to the Constitution. In this introduction to directives, we want to emphasize this and encourage you to do your EOLCs.

This was pretty radical at the time. Before this, the King was God’s representative on earth. The very notion that the King was not needed suggested that God’s plan, at least his previous ones, was flawed. Of course, the founders would argue that allowing people to follow God and not be impaired by a “bad” King made more sense and allowed people to be closer to God. And the founders were not suggesting that God was not the supreme ruler of man or that religion was bad. If they believed this, it would be in the Constitution or the founding documents: it’s not.

As long as God and Kings were battling it out for your rights and responsibilities, you didn’t really have a lot of personal responsibility. You just obeyed their rules.

As Americans, we the people are in charge. Evidence of how important your rights are, are all around. Nowhere are they stronger than in our beliefs in the right to life. For example, abortion and end-of-life medical treatments for patients in a coma or a vegetative state are among Americans’ most precious and controversial rights.

In both cases, our Constitution is required to ascribe rights to you, and if necessary, protect those rights. The question also centers on if you’re a person: an individual. If you’re a person, you have rights, if not, you don’t. And you don’t have the protections of the Constitution.

In the first case, a central argument of scholars, ethicists, and religious leaders is whether a fetus is a person, or something else. In other words, if you’re a person, ending your life looks like murder. If not, no person’s life was taken. In the other case, there is no question of whether you are a person, you are. The question is who should be making choices for you. If you’re a person, you have the right to make your own choice, and you are a person. The problem is that if you are now unable or incompetent to respond to questions about medical interventions to prolong your life. This is why we want to emphasize EOLCs in this introduction to directives. In other words, if you don’t do them, it becomes difficult to figure out your wishes,

Super Agers seem to get this. Everyone we found for example said, I’ve lived a long life, and it is my responsibility to manage my life through the end. My life, my choices. Most don’t want eternal life, and they don’t want to die in a hospital. They use advance directives (1) to address important issues and (2) not burden their families. Their advance directives tend to be more thorough than most. Super Agers have considered all or most of the issues below.

AMD Super Ager Story

Why the issues became important for Super Agers varied. Here’s one of their stories.

Mary had been involved with her rural Church for over sixty years. When she was a girl over 500 people attended Sunday services, today it’s 75. The greatest challenge of the Church is maintaining outreach services with the dwindling congregation. Where once the church performed hundreds of baptisms and weddings, today it’s last rites and funerals. The Church is active in providing seniors’ meals and residential assistance. The Church had even built an apartment building onsite that serves as a parsonage, community kitchen and resident for senior members of the Church.

Mary believed in her Church’s teaching that health was more than biological and demanded cognitive participation. That she was responsible for her own health and she was to pursue a “full life.” Life preserving technologies used to preserve less than a full life was not proper. It would deplete her resources and burden her community. She wanted those resources and energies used to help younger members of the community. Mary witnessed her sister trying to keep their mother alive on medical technologies. Their mother had serious dementia, diabetes and heart disease. She lived for five years in a hospital bed with the aid of feeding tubes, numerous trips to the hospital and regular injections. Mary’s sister couldn’t bear to see her Mother die.

Mary couldn’t bear to see others go through what she went through seeing her mother helpless, completely dependent on others, and always confused and frightened. Mary’s mother had no advance medical directive. Mary had an Advance Medical Directive and made sure everyone knew what it was and where it was. Her ADM made it crystal clear that once she couldn’t eat, dress or use the restroom on her own, she was through with medical interventions. No feeding tubes, ventilators, or operations. “If I don’t want to eat or drink or can’t, that’s it. Don’t force me. Manage my pain but keep me conscious. Don’t keep me from meeting Jesus. Whatever suffering I do in the end pales to His.”

Do Your EOLCs When Your Relatively Healthy, Wealthy & Wise

CarePlanIt believes AMDs are important and should be done when an Ager is relatively healthy, wealthy, and wise. For example, when you’re in your sixties. Or a period when you’re healthy (not sick), mentally sharp (not fuzzy or stressed out), and feel relatively financially secure (not dealing with a financial crisis). This is when you can make good decisions. This is also when you’re in the best position to consider God, family, and community.

Advance medical Directives (aka Living Will) are documents that say what you want from the medical community when you cannot.

Please review our end-of-life directive document summary. You may think you have your end of life documents in order, but 95% of seniors we interviewed didn’t know how to manage issues involving Emergency Medical Responders if they were unconscious or incompetent. Click here for a summary table.