The Art of Choice

I was stopped in my tracks the other day while I walked past a nursing home.  It was not the nursing home I work at so I did not know the person being wheeled to the ambulance, but I knew the look.  The look of absent.  The look of dying, not actively, but not living. When I see someone in that position, I feel for them, and I also hope I am never in that type of situation.

But I want to do more than hope, and I want to do more than just ‘feel for them’.  The only good option at the moment is called a power of attorney for health care (sometimes known as a “Living Will”) in which a person can name someone to speak for them if they cannot speak for themselves, and allows them to indicate what level of medical intervention they favor.  I recommend that everyone fill one out, no matter what age you are since accidents can happen, and keep a copy in your wallet. If anything ever happens to you, God forbid, at least your family will know what you would like.  They won’t have to agonize about it, feel guilty wondering if they made the right choice, and it creates fewer opportunities for fighting amongst family members who disagree about what to do. So, don’t wait until illness comes upon you especially because some illnesses can progress so quickly that a person may be unable (due to cognition or being under the influence of major pain medication) to sign legal documents.  

The problem at my nursing home, however, is that many people do not have close family or friends they can name as their power of attorney agent; sometimes people have alienated their family, or they don’t have many family members to speak of, and other times their families just don’t care.  What happens then is many of my patients ping pong between the hospital and the nursing home, getting procedures and treatments they might not have chosen if they were aware enough cognitively or understand the prospective outcomes. Their doctors don’t always know them well enough to speak for them either.  There are many reasons for that, from the forgivable (they never knew the patient before they became confused or nonverbal) to the worst (they don’t really do their job and see the patient regularly or they don’t like having uncomfortable conversations like that because death is seen as failure in medicine).  

For all of these reasons, I ask patients about their wishes.  I don’t see it as forcing my beliefs on them, since they can indicate their level of desire for medical intervention anyway, but as a way to ensure that their wishes, whatever they may be, are followed. I see it as a way of helping that patient be in charge of how they want to live their life. Sometimes it is difficult because I don’t think the patient understands the medical technology as well as they should to make these decisions.  But I know just because we can do something doesn’t mean we always should.  As is in the case of many elderly I encounter-the chance of a meaningful recovery after said surgery, procedure, intervention, is slim and might only give them a few more weeks-of suffering, not living. Its funny, but it seems difficult for us to accept the ‘expertise’ of doctors and the like when we are dealing with issues we all experience-health, parenthood, religion, etc.  We don’t like someone telling us what we should do, and we certainly don’t like them possibly exposing that we don’t have it all together). There is a difference between deferring to their expertise and blindly following.  Our own Church history has cautioned us against that.   

 I recently read an article that asked if thre is ever an age that is too old to have surgery.  On the message board, someone said this, “One of my deepest concerns regarding the “Right to Die ” movement, is that it quickly…becomes the obligation to die”- A Gross. I couldn’t agree more.  There are many moments where it seems money or a person’s perceived ‘worth’ to a society is the leading battle cry.  I am not trying to romanticize disabilities and debilitating diseases, but there is more to life than what kind of money you can earn or how much work you can do in a day. 

However, as Dr. Daniel Callahan said in this article, “Doctors endlessly complain to me about excessive patient expectations of medical miracles, or those of their family members. There’s nothing we can’t do for an old person…This is considered progress, and it’s considered ageism to be skeptical”. This is, I surmise, because the alternative is not very appealing.  The thought of feeling grief, admitting to being out of control or finite, are not very welcome feelings.  The irony for me however, is that we need to be open to thinking about death to be fully alive and open to the questions deep within. 
Lauren Ivory earned a Master of Divinity degree from Aquinas Institute of Theology in St. Louis and completed her chaplain residency at the Cleveland Clinic in Ohio. Originally from Northern Michigan, Lauren is now enjoying her new city of Chicago and working on the north side as a health care chaplain/’storylistener’. When she isn’t working she can be found spending time with friends, reading, exploring unique things about Chicago, traveling to see family and friends, listening to music, and dancing.
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About Lauren Ivory

Lauren Ivory is a hospital chaplain working on Chicago's diverse north side. After receiving her Master of Divinity degree at Aquinas Institute of Theology in St. Louis, MO she went on for further hospital ministry training at the Cleveland Clinic of Ohio. On the side, she enjoys helping couples plan wedding/commitment ceremonies and works with couples as a certified premarital guidance counselor.

2 thoughts on “The Art of Choice

  1. As a older middle aged man that brought Communion and the prayers of our community to a number of terminally ill people for years I can appreciate exactly where you are coming from. One of the aspects of dying that seems to be forgotten (in the current debate of health care reform in particular) is the respect of the spirituality of these people. I have witnessed very powerful religious experiences that occur during the acceptance of death process for these people. It is sad to think that these people are simply skin and bone without souls in this period of their lives. Unfortunately, a few years back when I committed myself to work with younger adults I had to trade off bringing communion to terminally ill. You have brought back wonderful memories of the mingling of heaven and earth especially in the last days of someone’s earthly life. They deserve far more dignity than we as a society have evolved to. Perhaps Eucharist can be a hope we can bring them so I am going to bring this up as a discussion topic at our next group meeting.

    Thank you for sharing your profound observation.

  2. Thank you Jerry! Good to know it makes some sense! We can lose so much in those last moments if we don’t have the person truly present, able to relate.

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