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home > services > elder care ministry > making end-of-life decisions Part of being a good steward is proper planning for one's estate. We plan everything: our careers, our schedules and appointments, vacations, and our retirements. However, many Christians fail to take the time to plan for the orderly disposition of their estate at death. The one area that most of us avoid planning is the end of our life. Yet, if we don't plan others take over at the very time when we are most vulnerable, most in need of understanding and comfort, and most longing for dignity. Big issues confront us when we think about our own death or that of someone we love. Our attitudes and beliefs about our religion, suffering, pain, loss of consciousness, and leaving behind those we love come into play. We can let things unfold as they may. As good stewards of all that God has blessed us with in life, we need and should take the time to properly plan. Following are tips you can use to help you plan for the decisions that must be made at the end of life. This is not intended to provide a comprehensive planning tool. It outlines areas we need to think about, whether we are caring for someone who is already incapacitated, or making decisions for ourselves. You should also order our free brochure on the Art of Gift Planning and When the Time Comes. You can order these FREE brochures by clicking here. • What do you need to talk about?
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Financial Decisions -
Why would I want to prepare
an advance directive? • Mental Illness or Developmental Disability Begin with yourself. Try to confront and understand any fears you might have: do they relate to the possibility of pain? Loss of dignity while undergoing treatment? Not being clearly understood by those around you? Being alone? Being overly-sedated or in a lingering state of unconsciousness? Leaving loved ones or unfinished projects behind? Leaving your loved ones without adequate financial resources? Dying in a strange place? Once you know that you want to explore these topics and make some plans, most experts suggest that you begin by talking. Talk openly to family and friends about your values and beliefs, your hopes and fears about the end stage of your life and theirs. Use "openings" in conversations, such as recalling a family event and talking about a future event where you might not be present. Talk about whom you wish to leave a possession to, whom you'd like to have near if you were seriously ill. Ask your doctor for a time when you can go over your ideas and questions about end-of-life treatment and medical decisions. The Baptist Foundation of Alabama can also help you prepare an Advanced Directive which contains the Living Will and Health Care Proxy. There is no charge for this service. If you are already ill, ask your doctor what you might expect to happen when you begin to feel worse. Let him or her know how much information you wish to receive about your illness, prognosis, care options, and hospice programs. Discuss with your lawyer and/or financial adviser whether your legal and financial affairs are in order. Talk to The Foundation's Office of Development about charitable gift planning options and our Office of Ministry or your pastor about spiritual concerns. What do you need to talk about? Specific issues relate to the end of one's life. They include:
Sometimes the easiest place to begin taking control of planning is in your estate and finances because the content is more concrete. Make sure you have a valid, up-to-date will, or trust documents if desired or needed. A durable power of attorney for financial affairs is a legally binding document that you prepare, or have prepared for you to sign, that designates a trusted person to act for you if you become incapacitated. A lawyer should help you complete these documents or you may have The Baptist Foundation of Alabama provide this at no cost. Contact The Office of Development for more information at 334-394-2001or email plannedgiving@tbfa.org. Keep all your insurance information - medical, long-term care, life and special needs policies - in an accessible place. Tell a trusted person where these documents are located. You should also think about, and write out, instructions for your funeral and burial preferences, and how they will be paid for. Keep a list of your documents in an accessible place, and either give a copy to a trusted relative or friend or let them know where they can find it when needed. In cases where The Baptist Foundation of Alabama is requested as Executor or Trustee, a copy will be kept in The Foundation's vault. Medical advances make it possible to keep a person alive who, in former times, would have died more quickly from the serious nature of their illness, injury or infection. This has set the stage for ethical and legal controversy about the patient's rights, the family's rights and the medical profession's proper role. To complicate matters further, the state also has an interest in protecting its citizens from harm. Each of us have the constitutional right to request that medical treatment be withdrawn or withheld. The right remains valid even if you become incapacitated. Another aspect of end-of-life decision-making is the right to insist on receiving, rather than refusing, treatment. This issue relates to "medical futility," when medical personnel deem further treatment to be useless except if in the nature of comfort or palliative care. To begin, understand that you have the right to make your own decisions about your care. You can also appoint an "agent" to be your proxy or surrogate should you become incapacitated. In the event you become legally incapacitated (which may require involvement of both medical experts and a court of law) very specific legal steps must be followed before decisions about your care are made. All states have adopted laws that make it easier for you to plan for the care you wish to receive should you not be able to communicate these wishes in the future. These means are called "advance directives" and take different forms in different states. No one can force you to sign a directive, but they are a helpful tool for you and for those who must step in for you. The Foundation can assist you in preparing this document. There is no cost for this service to Alabama Baptists. Call the Office of Development at 334-394-2001or email plannedgiving@tbfa.org. Advance directives are written instructions which communicate your wishes about the care and treatment you want to receive if you reach the point where you can no longer speak for yourself. Medicare and Medicaid require that health care facilities that receive payments from them provide patients with written information concerning the right to accept or refuse treatment and to prepare advance directives. Every state now recognizes advance directives, but the laws governing directives vary from state to state. Probably the most commonly used form of advance directive is the durable power of attorney for health care. A more limited type of advance directive is the living will. There are important differences between these two documents. The durable power of attorney for health care (also called the "medical power of attorney") names someone - a relative or friend - to make medical decisions for you when you are not able. Depending on the state where you live, the person you designate is called an agent, attorney-in-fact, proxy, or surrogate. A durable power of attorney deals with all medical decisions unless you decide to limit it. You can also give specific instructions about treatments you want or don't want, or about other issues that concern you. For example, your agent will have access to your medical records unless you limit this right. Because a durable power of attorney is a legal document, special forms are available and the power of attorney must be signed to be valid. Some states require witnesses and have specific rules about who can witness. It is important to select a proxy who knows you well and whom you trust. You should also name a backup proxy in case the first person is unavailable. A relative or friend can be your proxy, but an attending physician or hospital staff person usually cannot be. In many cases where one has no immediate family or family that lives in the same area, The Baptist Foundation of Alabama can serve; within certain established guidelines. For more information regarding these guidelines, contact the Office of Development at 334-394-2001or email plannedgiving@tbfa.org. The agent will be able to make all decisions regarding your health care, from flu shots to the need for surgery. And your agent or proxy can decide whether to withdraw or withhold life-sustaining procedures based on your established wishes. While you can be as specific as you wish in the guidelines you give in the document, remember that your agent must also have the flexibility to make decisions in changing circumstances. The living will, in some states called "instructions," "directive to physicians," or "declaration," states your desires regarding life-sustaining or life-prolonging medical treatment. These instructions generally apply to specific circumstances that may arise near the end of your life, such as prolonged unconsciousness. They do not appoint a surrogate to make decisions for you. Most states include these types of instructions in their medical durable power of attorney forms. Not all states recognize separate living wills as legally binding. The Foundation, however, recommends using the full Advanced Directive format. For information on advanced medical directives, click here. Why would I want to prepare an advance directive? It is wise to prepare an advance directive so that medical personnel and your loved ones know what care and services you desire and what treatment you would refuse if you were able to communicate your wishes. You also can designate the person or more than one person who you would like to make decisions on your behalf. In a surprising number of families, there is disagreement over what a very ill relative would prefer. The advance directive makes your wishes clear. Whom should I select to be my proxy or agent? Choose a responsible person to be your surrogate who shares your values and beliefs about medical care and dying. You must also make sure that the person is willing to take on this responsibility before you name her or him in the directive. An alternate should also be selected (and informed of your choice). Some states do not allow certain people, such as health care providers or health facility operators, to serve as agents. Remember also that the person you select to be your surrogate does not have to be the same person who oversees your financial affairs. Can someone take over making decisions before I'm ready? Though laws vary by state, most states ensure that you remain in charge of your care as long as you are able. Usually laws are in place that require at least two physicians to declare you to be incapacitated. Agents/proxies are not allowed to commit you to a mental institution or to consent for experimental mental health research, psychosurgery or electroconvulsive treatment. Your proxy may not deny comfort measures for you. Advance directives must be reviewed periodically and kept current. Keep the original and give copies of the signed documents to your proxy/agent (including alternates), your physician, and your hospital. Put a card or notation in your wallet or purse stating that you have an advance directive. You may also leave a copy with your lawyer. Some people take their directives with them when they travel. If you spend extended time in another state you should also complete advance directives there, using that state's forms and rules. Advance directives remain in effect until they are revoked. Any written change you make on a directive may invalidate it, so consult with a professional or hospital if you wish to make changes. Where can I get forms and instructions? A local hospital, senior legal service or senior information and referral program, your physician, or The Baptist Foundation of Alabama usually have forms appropriate for your state. Attorneys may also draft their own forms. What if I don't sign an advance directive? Someone has to make decisions when an ill person cannot. Without directives in the person's medical or hospital files, and without the appointment of a surrogate through the durable power of attorney, your doctors, hospital staff and loved ones will do the best they can. To your spouse or child or life-long friend, this might mean struggling with what they think you would want. To the medical staff, it means letting their training and professional experience guide them. Unfortunately, in a world of good intentions, that training has traditionally led health care professionals to do all they can to keep you alive. But the ways all these wonderful people employ may not be what you want. Eventually, of course, a conservator (or guardian) could be appointed by a court. A public agency can request designation of a conservator and, if your family cannot be located, the conservator may be a public agency. Mental Illness or Developmental Disability If the person for whom decisions must be made has a mental illness or developmental disability, various federal and state laws apply. No one can be committed to a mental institution, for example, without specific legal proceedings. There is much that we can plan and attend to in advance of our own death. We can make our wishes known about where we want to be, who we want to be with and what we want to happen to us and around us. We can set up ways to pay the costs of care and even pay for our own funeral. We can make arrangements to create charitable gifts for Baptist ministries and causes through our wills and trust documents. But financial and legal planning and medical advance directives must be made with the knowledge that some day other people will have to implement our wishes and live with the results. For that reason our plans should, when possible, allow for flexibility and trust in the discretion of our surrogates. Planning for incapacity or the end of one's life is essential proper care during incapacity or for the orderly disposition of one's estate. The Lord has blessed you in life in many different areas. This may be in your talents, careers, family, and even the accumulation of estate assets. Consider including a portion of what God has blessed you with to create a "Kingdom Legacy." This is a gift made, whether through a memorial endowment or trust, that will continue to give to the Lord's work until He returns again. Proper planning for one's estate is a both a smart decision and an act of good stewardship. For more information on planning one's estate, contact The Office of Development at The Baptist Foundation of Alabama by calling 334-394-2001or email us at plannedgiving@tbfa.org. You may also write us at: The Baptist Foundation of Alabama The Baptist Foundation of Alabama has been serving Alabama Baptists since 1940. * Always seek the advice of competent legal and/or financial professionals. |
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