#1 MAKE YOUR WISHES KNOWN: My mother’s passing was particularly sweet because we knew what she wanted. As Mom declined, she had discussed her death with her doctor and her options. She then made her preferences known to us. The hospital staff was very kind to all of us as they administered Comfort Measures Only. My mother also made a specific request of her family. She asked that we hold her hand.  For ten days, we all took turns around the clock holding her hand and loving her. We were powerless to stop death, but we could do as she had asked. One grandson played the guitar, and we all sang songs to her. Others recalled favorite memories or re-told family stories. Surprisingly, there was much laughter. Because we knew Heaven was her destination, we could also comfort her and ourselves by reading her favorite scripture aloud—I Corinthians 13. At some point, each and every one of us held her hand. It was such a simple request, but Mom’s spoken need for affectionate contact gave us a reason to work together for an extended period of time.  While Mom had empowered her family with a focus, please hold my hand, she also empowered her guardian with a legal document and clearly stated preferences.

#2 LET THEM KNOW WHO’S IN CHARGE OF YOUR CARE: Give your Medical Representative, your doctors, and your hospital copies of your notarized MEDICAL POWER OF ATTORNEY. Equipping your Medical Rep or Guardian with legal documents opens doors and removes unnecessary delays. Doctors and nurses are trying to protect you by adhering to HIPPA laws*. Make it easy for them to know with whom they should be discussing your care. Some families contain busy bodies or dramatic, even demanding personalities. Others can be understandably incapacitated by a crisis. Protect yourself and your Medical Representative with a notarized Medical Power of Attorney.

If you use your state’s ADVANCE DIRECTIVE to appoint your Medical Representative, we suggest you only fill out the portions of the form concerned with your representation. It will then be necessary for medical personnel to consult your representative and not just a form. Also, your treatment preferences may change depending on future circumstances you cannot know now. If you specify detailed choices, you undermine the power of your Medical Representative. You might also set up a conflict between your Medical Rep and the doctors and nurses caring for you. Consider the stroke victim who needed to re-learn swallowing. This gentleman was almost denied treatment because he had checked the box on his Advance Directive saying “no tube feeding.” After his family went to battle for him, he was temporarily intubated, re-learned swallowing, and lived an additional two years. By discussing your anticipated choices with your Medical Representative in detail,  conflict with your medical team can be avoided by allowing your Rep to respond flexibly as your health care situation changes. According to  Joni Eareckson Tada (When Is It Right To Die?, page 161), the crucial question is Do you want to be represented by a form or a person?

#3 HOLD ANNUAL FAMILY MEETINGS: Initially, the most important thing is to validate the authority of your Medical Representative to carry out your choices. Clearly express your wish that your family support him or her. It is worth focused effort now to achieve understanding and shared expectations, so your preferences will be followed and your Medical Rep will have the support he or she will need. If there are difficult decisions to make at the end of your life, it is your Medical Rep who will make them. Some people believe that the way to express their love and loyalty is to pursue extreme curative care in the ICU until death. You, however, may wish to die in your home with Hospice assisting your family. Leading your family through difficult discussions now may avert conflict and misunderstanding later. How much detail you wish to discuss regarding your choices for end of this life care will depend on the readiness of your people to discuss death. Thankfully, such discussion does become easier over time.

#4 DEFINE YOUR “CHOOSING LIFE”: Does choosing life (Deut. 30:19) mean extreme curative care—whatever it takes, fighting to the last breath—to extend our life? Sometimes, yes. We each have heroes or heroines who have endured much to recover and be there for their families and fulfill the purposes God has given them. We honor their choice of life, their fighting spirit and determination to live for others. However, we can also be choosing life when we accept that our days are numbered, receive palliative care as did my mother, so we might say our good-byes and treasure our last days. There is a time to die (Ecclesiastes 3:2). Much can be accomplished at the end of this life—affirmation and blessings given, forgiveness asked or granted, testimonies shared, and hope passed on. Exploring your beliefs and how they apply to the end of your life requires contemplation, prayer, and Bible study. Please ponder these challenging questions and ethical issues before you face them.

#5 YOUR WISHES REGARDING MEDICAL EMERGENCIES: If your heart or breathing stops, do you wish to be resuscitated? If you are young and healthy, this is assumed. Both ambulance and hospital emergency personnel are required by law to provide cardiopulmonary resuscitation (CPR) unless they receive a separate directive that states otherwise. DNRs or DO NOT RESUSCITATE ORDERS  are intended for people whose poor health gives them little chance of benefitting from CPR. This is a voluntary choice, of course. If you have an advanced illness or have become frail, do you want to have CPR? If you do not want to be resuscitated, fill out a POLST form (Physician Orders for Life-Sustaining Treatment) with your doctor, nurse practitioner, or physician’s assistant and have him/her sign it. POST A COPY OF YOUR POLST FORM ON YOUR REFRIGERATOR. These directives instruct ambulance personnel NOT to attempt CPR.

#6 YOUR WISHES REGARDING PLACE OF CARE:  Do you wish to die in a hospital or at home? It is the mission of Hospice to enable people to  die naturally and comfortably in their homes. “Home” can sometimes be a skilled nursing facility or assisted living if your people are able to render assistance beyond what paid staff is able to provide. Hospice is paid for by Medicare and provides medical equipment such as hospital beds, instruction for caregivers as well as weekly nurse visits, and supervised pain medication. See the Heritage of Hope Health Video or our website resource page for more information on Hospice. Be aware that choosing curative care disqualifies you from Hospice as long as that choice is in effect, and choosing to be an Organ Donor would require that you die in a hospital.

#7 YOUR WISHES REGARDING LEVEL OF CARE: CURATIVE CARE includes both NORMAL CARE and INTENSIVE CARE. At what point do you wish to decline the more extreme, heroic measures of intensive care and just receive “normal care?” If you opt for Intensive Care, then you must also specifically consider intubation, advanced airway interventions, and mechanical ventilation or life support. LIMITED ADDITIONAL INTERVENTIONS would include antibiotics, IV fluids and basic medical treatment. While choosing Limited Additional Interventions disqualifies you from Hospice, it generally avoids the intensive care unit. At what point do you wish to have  Palliative care? Palliative care means COMFORT MEASURES ONLY. Hospice care is an example, although some, like my mother, receive Comfort Measures Only in a hospital setting. You are choosing to allow a natural death, but your comfort will be maximized through symptom management. Please discuss these options with your Medical Rep. We cannot know the circumstances in which they may be required to make hard decisions. You could however, discuss possible scenarios and what factors would influence your preferences.

  • To everything there is a season, a time for every purpose under heaven: A time to be born, and a time to die. Ecclesiastes 3:1-2.
  • Therefore choose life, that both you and your descendants may live. Deuteronomy 30:19B
  • Precious in the sight of the Lord is the death of His saints. Psalm 116:15
  • Fulfill my joy by being like-minded, having the same love, being of one accord, of one mind. Philippians 2:2

#8 SHARE YOUR FAITH: In the HOH VIDEO SERIES, Ida Strickland states, “My parents showed me how to live and how to die.” We can do the same for our children by choosing faith over fear and looking beyond death to glory. Believing the Bible and looking at death as a transition to eternal life changes everything! Our faith removes much of the sting or grief for us and those who love us (1 Corinthians 15:55). Our last days on this earth may be an outstanding opportunity to share our core belief in Jesus Christ.

#9 SHARE YOUR GAME PLAN: I anticipate choosing not to fight my last illness, so I have been preparing my family for this preference for years. Why? There is a tendency in our culture to view death as a failure, to call on those near the end to be fighters and encourage them to somehow beat the disease that afflicts them. Ecclesiastes 3:2 states eloquently that there is a time to heal, but there is also a time to die. Scripture uses numerous metaphors to picture the end of life as a victory (I Cor.15:55), as finishing the race (Acts 20:24), as going home (2 Cor. 5:8), not as defeat. Jesus Christ himself declared his mission complete from the cross when he declared, “It is finished!” (John 19:30) I wish to do the same, and I want my family on my team. What is your game plan or exit strategy?

How do I prepare my family for my own finish line? I mention death now and again. It is not a taboo subject in my presence even though I am now the oldest member of the family. I also remind them that their father and I have been fighting for fitness our entire adult lives with vigorous exercise, a healthy diet, lots of water etc.  We hope to make it clear that we are not striving for longevity or denying the reality of death. Rather, we work out to prevent avoidable, degenerative diseases. Together, we fight for good health now that we may enjoy the numbered days God gives us . . . and we pray for strength to match our days (Deut. 33:25) that we may bear much fruit! Since our efforts could easily be misunderstood, we state repeatedly that we are not fighting for a longer life—but a healthy one. We are purposely setting the stage for mutual understanding and release when our departure times come . . . when it is time to hold hands.

#10 SHARE YOUR PREFERRED COMFORTS: Like my mother, I would love to have a dear one hold my hand. I would also enjoy having God’s Word read to me. Listening to worship songs together would be comforting and uplifting. Praying together in thankfulness for all God has done would be especially sweet. Most of all—I would like to hear the hearts of my loved ones as we say our good-byes—for now. If there is any unfinished business in my relationships, I would very much like the opportunity to heal any hurts I have caused. Life can be messy, but love transcends and heals by the power of the Holy Spirit. What are your wishes or preferred comforts?

HOW CAN YOU MAKE YOUR DEATH EASIER ON YOUR PEOPLE? Planning ahead and preparing your people does make your death easier on the ones you love. More specifically, let them know your wishes regarding who is in charge of your care when you are not. Consider, decide, and share your wishes about your care at the end of this life. Finally, share your faith, your game plan, and your preferred comforts. With these decisions made and communicated, your loved ones can honor your wishes when the time comes and know they have done so. Such knowledge can be very comforting to those you will be leaving behind.

  • When the perishable has been clothed with the imperishable, and the mortal with immortality, then the saying that is written will come true: “Death has been swallowed up in victory. Where, O death, is your victory? Where, O death, is your sting?” I Cor. 15:54-55
  • However, I consider my life worth nothing to me: my only aim is to finish the race and complete the task the Lord Jesus has given me–the task of testifying to the good news of God’s grace. Acts 20:24
  • Yes, we are fully confident, and we would rather be away from these earthly bodies, for then we will be at home with the Lord. So whether we are here in this body or away from this body, our goal is to please him. 2 Corinthians 5:8-9
  • When Jesus had tasted it, he said, “It is finished!” Then he bowed his head and gave up his spirit. John 19:30
  • As your days, so shall your strength be. NKJV  Your strength will equal your days. Deuteronomy 33:25b NIV

*The HIPAA Privacy Rule regulates the use and disclosure of Protected Health Information (PHI) held by “covered entities” (generally, health care clearinghouses, employer sponsored health plans, health insurers, and medical service providers that engage in certain transactions.)