CHARLTON: End-of-life planning requires attention

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By Dave Charlton

Thinking about death is not easy, especially when it is the prospect of your own. When one considers the complicated nature of the dying process in this time of highly advanced medical technology, however, it is of vital importance that people consider how they want to deal with end-of-life care.

What do you need to know in order to prepare for your own end-of-life care? There are several matters to which every person should direct their attention, the first being the importance of talking about their wishes with their loved ones.

As important as it is to have legal documents available when critical decisions need to be made, it is absolutely essential that our loved ones be aware of our wishes. Though it can be very difficult to have such a conversation, doing so lifts the uncertainty from families when they are called upon to make decisions about the care of a loved one.

When a patient is unable to speak for himself, and doctor asks the family. “What do you want to do?” the burden on the family is greatly eased if they know the wishes of their loved ones. If you have never had this conversation with your family, you need to do so as soon as possible.

Do not allow your family members to be in the position of making uninformed decisions on your behalf.

There are also several documents related to end-of-life care that you should prepare. Documents that relate to end-of-life issues are known as Advanced Directives, and the one that is most familiar is the Living Will.

When you enter a hospital, you are asked if you have a Living Will. The purpose of a Living Will is to share your decisions about medical care if you are unconscious or are too ill to communicate those decisions. A Living Will only comes into effect when you are unable to express your wishes; otherwise, you remain free to accept or refuse medical treatment (helpful information about Living Wills as they relate to Kentucky law can be found online at

http://lrc.ky.gov/Lrcpubs/LivingWill.pdf, http://ag.ky.gov/civil/consumerprotection/livingwills/Pages/default.aspx, and


A Living Will relates a person’s wishes in relation to four important areas of medical care, the first being the designation of a Heath Care Surrogate, which is a person, or persons, that you designate to make decisions on your behalf if you are unable to make them for yourself.

In addition a Health Care Surrogate individuals also should consider the selection of a Durable Power of Attorney that can be selected. While a Health Care Surrogate is empowered to make decisions about an individual’s medical care, a Durable Power of Attorney can make decisions on matters beyond health care, such personal and financial issues.

The person or persons should be notified that they have been chosen to serve in such a capacity and you should verbally express to them the exact nature of your wishes, such as your desires related to life prolonging treatments, such as artificial feeding or hydration, and whether or not you desire to be an organ donor.

There are several important considerations to keep in mind about Living Wills. First, it is not a legal requirement that any person complete a Living Will. Though you will be asked by a doctor, hospital, or nursing home if you have a Living Will, you are not required to complete one, and the absence of one will not prevent your receiving medical care. A Living Will is an expression of your wishes regarding treatment, not a requirement for receiving care. Once completed, changes can be made at any time, but care must be taken to rescind all previous versions of a Living Will. Once your wishes are formalized in a Living Will, the person designated as your Health Care Surrogate cannot make changes in your Living Will or go against your wishes. Living Wills, and Health Care Surrogates, also have some limitations.

Living Wills do not apply if a patient is pregnant. Kentucky law requires that pregnant women receive life-prolonging treatment, including the use of artificial nutrition and hydration, except in the event that a doctor has determined the baby cannot be saved or the woman is either harmed by the treatment or it causes uncontrollable pain (a similar law in Texas led to the recent case of Marlise Munoz, who, because she was pregnant, was kept alive against her family’s wishes).

Health Care Surrogates may authorize the use, or nonuse, of artificial nutrition and hydration only in very particular circumstances – when death is imminent, when the patient is permanently unconscious and the decision is consistent with an advance directive of the patient, when artificial nutrition and hydration cannot be absorbed by the body, when the burden of providing artificial nutrition and hydration outweighs the benefit. Also, artificial nutrition and hydration must be provided if needed for comfort or pain relief.

A final document is a DNR, or Do Not Resuscitate order. A DNR (sometimes known as an AND – Allows Natural Death) is a document that communicates a patient will not receive CPR or any procedure that resuscitates him or her in the event that breathing or heart stops. A DNR does not affect any medical treatments a patient is receiving; it only guarantees they will not be resuscitated if this is their wish.

If you have not completed any of these documents or had a conversation with your family about your wishes at the end of life, it should be a priority to do so as soon as possible.


Dave Charlton is pastor of First Christian Church. His column will appear every other week. You can reach him at davidpaulcharlton@gmail.com.