Regular ElderBlog readers will recall that Mom was hospitalized back in April. During the two-week stay, she was run through every big machine in the facility’s inventory: MRI, CT, EEG, TEE, EKG…you name it. She was IV’d, catheterized, and spoon-fed. She was evaluated and rehabilitated. In other words, she got the full treatment. Everything they could have done, they did.
Some of the lesser bills have been received and paid already. We now have the bill; the one from the hospital with all of the big numbers. It’s in the tens of thousands of dollars.
Mom wanted (demanded!) to know the final cost and I told her. I also told her how it would all be paid. Thankfully, we’re going to wind up paying only a small fraction of the total out-of-pocket.
Mom considered this for several days. She also remembered that my father spent long months in agony while being treated with antibiotics before finally passing away last year. She remembered deciding then that she didn’t want to suffer the same fate. She put all of the factors together and told me quite earnestly that she never wanted this to happen again.
“You never want what to happen again?” I asked.
“I never want to be exposed to all of those machines again. I don’t want to receive all of that treatment again. I don’t want to spend that obscenely large sum of money again no matter where it comes from. I want you to see to it that this won’t happen again.”
I explained to Mom that it is my role as caregiver to see to it that she is as comfortable as she can be without my playing god. What she was asking me to do defied that definition. She held her ground.
So I went pragmatic. “If the same thing happens again (you’re found unconscious on the floor), the Piedmont Place medical staff is going to follow set procedure in rendering immediate care, and will have you transported to the hospital where they will follow procedure in determining causes, and seeking and implementing solutions. This is what they’re supposed to do.”
“I don’t want them to do it.” Mom was serious.
Rather than argue with her, I decided to pursue the issue elsewhere. My first contact was with our lawyer who not only didn’t say she couldn’t get her way, but did say that the state provided a legal document which ensures that she does.
It’s called a MOST form – Medical Orders for Scope of Treatment: a physician order sheet issued by the state of North Carolina Department of Health and Human Services. MOST asks the patient to select the level of intervention to be given in each area of treatment. The state mandates that the patient’s doctor complete and sign the document in the presence of – and at the direction of – the patient.
I was surprised at this development to say the least. It took away my arguments in opposition to Mom’s wishes, and it put me in a very uncomfortable spot.
My mind raced with the possibilities. I could see the dire circumstance when a medical professional would say, “Your mother needs (this, that or the other thing). And as her Caregiver and Healthcare Power of Attorney, I would be obliged to say, “No. Check your charts for the MOST form. Mom does not want that kind of treatment.” To my way of thinking, this is the same as me saying, “Let her die.” It seemed to me that I was at least on the edge of playing god.
I could see the medical professional stopped in his tracks; prevented by a piece of paper from doing what he knew to be necessary to save a life; to do what he believed to be the humane thing; to do what he was trained to do. I imagined the impact such a scenario would have on him as a person. And what if his belief system differed from Mom’s? Would he be obligated to follow his convictions or hers?
And what of the moral argument? This God-fearing woman was essentially signing her own death certificate. She’s playing god, and forcing my complicity. Knowing the end of someone’s days is God’s job, not Mom’s or mine. Would this displease Him? Would He shut us out of our eternal rewards?
Is a MOST form different from any other advance health care directive? Is it any different from a DNR or a DNI? Is the self-directed restriction of medical care the moral equivalent of suicide?
Since the Bible forms Mom’s belief system, I went there for counsel. It is my personal belief that the myriad rules of The Old Testament were necessary before the time of Jesus. I bring this up to explain why I did not consult The Old Testament. I believe that the teachings of Jesus provide all the guidance we need today; specifically Matt22:37-40 (CEV) in which Jesus says:
“’Love the Lord your God with all your heart, soul, and mind.’ This is the first and most important commandment. The second most important commandment is like this one. And it is, ‘Love others as much as you love yourself.’ All the Law of Moses and the Books of the Prophets are based on these two commandments.”
That’s all we need. The Son of God said so. But the closest He gets to mentioning suicide is the “love yourself” part.
A century later, the Apostle Paul wrote (1Cor3:16-17 The Message)
[Y]ou are the temple of God, and God himself is present in you…No one will get by with vandalizing God’s temple…God’s temple is sacred—and you, remember, are the temple.
In its proper context, Paul is saying that God will deal harshly with someone who harms another. A bit later (1Cor6:20 The Message), Paul wrote:
The physical part of you is not some piece of property belonging to the spiritual part of you. God owns the whole works.
The context for this second scripture comes a little closer: he’s saying that we should not do things that are harmful to ourselves.
All of this is a long way to go to find an answer to the question: Is the self-directed restriction of medical care the moral equivalent of suicide? And perhaps now we should add the question: Is suicide necessarily an act of self-loathing or self-destruction?
I am not nearly smart enough to answer either of these questions. I think the answer lies in the interpretation or belief system of the individual. But I do know that today’s medical technologies were not available to God’s children a hundred years ago, or a millennium ago, or in Jesus’ day. There cannot be a reasonable person alive who would think that God disapproved of the deaths of all of His children for all of time because they failed to use technology to sustain themselves beyond their natural lifetimes.
God never intended for humans to last forever. We know this because He did not create an earth of sufficient size or resources to sustain all of humanity forever. The notion is ridiculous on its face.
Let’s approach the matter of morality from a different direction.
God knows everything. There are many biblical references to support this. He knows the beginning from the end. He knows what’s in our hearts and minds. He’s known what our decisions would be since before He even created our species. If we accept this to be true, then He must know that Mom’s heart is filled with love for Him, and that her choice is driven by her best reasoning and purity of spirit.
What about the impacts her decision might have on others?
Life is built into us. By that I mean that it’s in our DNA to live; to survive. And because we are necessarily relational beings, our hope is that those who are close to us will similarly survive. When someone close dies, we deeply feel their loss. There is little relief in knowing that it is a certainty that each of us will one day die. The manner of death, therefore, is a non-factor in the emotional aspect of losing a loved one.
The first principle of medical practice is ‘do no harm.’ The practitioner’s training and experience then endeavors to do more than just no harm; they work to do good. There isn’t a single one of us whose life hasn’t been touched to the good by myriad hard-working, well-intended doctors, nurses and aids.
But these highly trained professionals are also human beings with many of the same values as the rest of us. How would one of these deal with orders that essentially say: ‘Don’t do what you can do?’ I can’t begin to know. But the fact that these good people spend their decades-long careers continually dealing with life and death suggests that they do find ways to cope.
The meeting was set and Mom dressed up for it. Lisa and I walked into her room followed shortly thereafter by the head nurse, the section nurse, the social worker and the doctor. Mom was undaunted by the number of souls crowded into her room — all focused on her.
The doctor conducted the interview. She explained the choices available on the MOST form and the consequences of each choice. She asked Mom about her wishes and recorded them on the form. “Comfort measures” and only short-term antibiotics were selected as the desired treatments. Great pains were taken to emphasize the meaning of each selection. At one point, Mom went so far as to take over the meeting to explain her wishes at length. If nothing else, she proved that she was of sound mind at the time.
The professionals in the room understood the proceedings without question. I, on the other hand, had many…the questions I’ve approached above.
While I am now fully informed and armed with an official document as backup, I am still somewhat uncomfortable with the prospect of using its powers someday.
For her part, Mom is content in the knowledge that her wishes – for her body to comfortably expire so her spirit can rise into heaven – have been sanctioned and will, most likely, be followed.
God knew since the beginning of time that it would be this way. I’m guessing that He can’t wait to see her.