Advance Medical Planning – February 10, 2012 Meditation

Advance Medical Planning
YouTube Video of Dharma Talk on Advance Medical Planning

Today I am presenting to you a talk on making advance medical decisions. I believe this is an important action that every one should take. I feel strongly about the importance of having these discussions, making these decisions, and completing the necessary legal documents.

Advance medical planning is a proactive way for each of us to take steps to have a voice in our medical care in the event we are unable to speak for ourselves. While frequently these documents cover end of life issues they can and do cover all of your medical decisions if you are unable to speak for yourself.

One document actually designates who will be your legal spokesperson. This could be anytime you are unconscious, say in surgery or as a result of an accident. It doesn’t need to be life threatening.

I do hope you will take the time to listen to or watch this presentation. Take some time with family or friends and have these discussions.

With Gassho,

Ryusho, Shonin

Slide01

Slide02Once life comes into existence then it is subject to the five phases of birth, growth, old age, sickness, and death. None of these are avoidable in the normal course of living. Nothing remains unchanged forever, the youth we once possessed will turn into old age, the health we once had will turn to sickness. Life begins with birth and all life ends with death.

What occurs in between birth and death as we undergo the transitions of life are the things we can act upon. We are heirs to the effects of our actions.

Making advance plans for your medical care helps to ensure your wishes will be honored and will help those who may have to make those decisions know they are doing what you would want them to do.

Slide03Not only is it prudent to have these documents prepared it is also beneficial to foster the conversation.

Having a conversation with loved ones, friends, people who are a significant part of your life is beneficial not just to ensure your wishes are carried out. The conversation also is a gift you can give to those who may need to make these decisions on your behalf. You can give them the gift of peace of mind and the assurance they are doing exactly as you would wish.

Some of the things to consider will be not just who will be the spokesperson for you but also others who may be impacted by the process. Not only designating say your spouse as your spokesperson you might also consider informing children or siblings of your intent to make someone your spokesperson. Also letting others know exactly what your decisions are can be very helpful to the person making the decisions so that all of your friends and other family know that it is your intent to have that person speak for you if you are unable.

A good place to begin the conversation is to consider what your objectives would be in different situations. At different times in your life you may change your medical treatment objectives. Where as when you are young some medical treatments may be more appropriate than when you age.

Slide04It is never too soon to think about what your medical wishes would be if you were unable to voice them yourself.

While generally we may think this applies only to the aged, it is in fact most appropriate for anyone of any age. It is certainly true that as we age it becomes increasingly important.

Slide05As you consider what kinds of treatments and care you would like in the event you are unable to make those decisions yourself, who would you like to help you or to speak for you? Including them and others into the conversation can make it easier for them to follow your wishes. Also letting everyone know that you have thought about this and have made some choices and expressed those wishes to others helps to ensure that you will receive the kind of support that matches your expectations.

Slide07What are your feelings about long term artificial feeding and hydration? This may be good or may be harmful. If you have multiple organ failures processing fluids may become more harmful than beneficial. For some though these options are perfect and provide benefits.

Forced artificial feeding and hydration can sometimes lead to other complications and possibly cause more harm than good. Knowing what your desired outcome expectations are will help in the event the decision needs to be made about these procedures.

Pain, no matter what you are entitled to be as pain free as is possible. The consideration here is that some pain medications also limit your ability to be fully present to your environment. Again, knowing what your wishes are will assist the decision maker because you have made it clear what you would have wished to be done if you had been able to speak.

Resuscitation is a complicated matter medically speaking. However letting your friends, family or care providers know what your wishes are will help them to decide how to proceed if your treatment requires resuscitation. Resuscitation can sometimes make matters worse. Knowing what your feelings and wishes are will help your spokesperson and the doctors in deciding which treatments will most honor your wishes.

Location, is something I feel does not get the consideration it should. When it comes to your care, your long term living, or even your death, what are your wishes regarding where you would ideally like these to occur? It may not always be possible but it may help in providing you the respect and care you want. Knowing if you would like to die at home if possible or if you have no preference can help in ensuring you have the comfort and peace you deserve.

Slide08

Slide09All the phases of life are natural, and unavoidable. In all things we are the benefactor of the causes we make, of the things we do. When we are not prepared we are more likely to suffer or act in unskillful ways. Facing death and keeping the name of the Buddha on our lips is the ultimate way to transition from this life to the next. Part of being able to die this way is making the causes in these moments when we are able to make and doing so with not only love of our own life but love of the lives of those who may remain after we are gone.

By making advance plans for our medical care at all phases of life is a gift we give ourselves because it is skillful thing we can do facing the uncertainty of life.

Making advance plans is a gift to others allowing them the peace of mind and the comfort of your preparations to know that they are doing what you wanted them to do.

Making advance plans for your medical care is an expression of our great appreciation for the life we have, the value we place on it, the value we have for our friends. Because we value life so much we also know that it will not remain unchanged. By fully embracing the fact of death we can better prepare for its eventual approach.

Slide10It is important to document your decisions. Just knowing what you want or only having discussed this with others is not enough.

Completing various legal forms and having them readily available, even possibly on file with your personal doctor or with a hospital can greatly improve the possibility that your wishes and those you want to participate in the process will be honored.

There are a variety of common documents, yet even these documents go by different names. Some of these documents in some cases may require a physician to complete at the time the decision is to be made, frequently these would be the DNR and MOST forms. Yet even still those may not be honored or significant in some medical facilities.

Because of there are so many different standards it becomes important to do some investigating to see which forms are available for you to complete. I should note that you may need either a lawyer or at the minimum a notary to finalize the documents.

At the minimum, and a good place to start is more than likely the Health Care Power of Attorney and Advance Directive/Living Will (They may also be known as a Advance Health Care Directive, or Durable Health Care Power of Attorney)

These forms will allow you to designate who your spokesperson will be if you are unable to speak for yourself. By filling out these forms you are able to state your desires for the kinds of care or the limits to care you desire.

The designation of your spokesperson may be a very critical thing to have documented and made binding. Some examples would be domestic partners, partners in same sex relationships, common law marriages, divorces that have not be finalized, adult children who do not wish their parents to make decisions, or situations where someone other than what your state considers your next legal spokesperson.

Again, documenting your decisions is critical and a necessary part of the entire process of making causes for your future. These documents may vary in different states and hospitals so investigate some to find what you need. It isn’t nearly so daunting a task so don’t be discouraged or put it off to some future time. Now is the most important time to do this good work.

Slide12An excellent resource and one I drew from in preparing this presentation is a small easily readable booklet by Hank Dunn titled: Hard Choices for Loving People

I did a search on the internet and you can find a PDF version or you may order a printed copy for your use or as a gift to someone you love and would like to talk about this with.

About Ryusho 龍昇

Nichiren Shu Buddhist priest. My home temple is Myosho-ji, Wonderful Voice Temple, in Charlotte, NC. You may visit the temple’s web page by going to http://www.myoshoji.org. I am also training at Carolinas Medical Center as a Chaplain intern. It is my hope that I eventually become a Board Certified Chaplain. Currently I am also taking healing touch classes leading to become a certified Healing Touch Practitioner. I do volunteer work with the Regional AIDS Interfaith Network (you may learn more about them by following the link) caring for individuals who are HIV+ or who have AIDS/SIDA.
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