How do you want to die? Have you ever thought about it? It’s a line of thinking most of us would probably like to avoid, but as a hospital chaplain, my job involves a lot of thinking and talking about death. And in the hospital where I work, chaplains also have conversations with people who are not near death about what they want to happen when they get to that point. Upon check-in, every patient is asked whether they would like information about Advance Directives. If he/she says yes, a chaplain will go visit him/her within the next forty-eight hours, carrying a blank South Carolina healthcare power of attorney form. Where I work, it is one of the basics of what a chaplain does. 

I was recently introduced to the Writing Refinery blog, where Elisabeth Kauffman is doing a great series on the ABCs of Writing Well. Not only did I learn a few things about writing, but I was also inspired to do a series of my own. When I tell people what I do for a living, they often have a lot of questions about what exactly it is that hospital chaplains do. In this series, I want to answer some of those questions. I’ll still be writing about other things as the muse descends, so I don’t know how long it will take to complete the series, but I think it will be interesting and fun. If nothing else, it gives me a chance to tell some of my favorite chaplaincy anecdotes from the past eight years that just haven’t fit into any of my other posts. The letter A was an easy one.

Advance Directive (AD) visits make up a sizable percentage of my calls. Normally, I’ll have at least one AD referral each shift, and sometimes as many as three or four. There are those people who are confused about what a healthcare power of attorney can do. Some of them don’t remember answering “yes” when the person at the registration desk asked if they wanted information about it, and when I explain what an AD is, they decline. Others want help making sure that one of their no-good relatives can’t get his hands on their mother’s money or house when she passes away. I patiently tell them that all we handle is the healthcare power of attorney, which only applies to healthcare decisions, not financial or property issues.

When a patient does want to hear more about the healthcare power of attorney, I explain it briefly like this: “This document lets you designate a person to make your healthcare decisions if you are not conscious and able to make them yourself. We’ll need that person’s name and contact information, but not their signature. You can also write in up to two alternate people, but that’s optional. Then the form asks for your specific wishes in three areas. The first is organ donation. If you do want to be considered as a potential organ donor, you initial here. If you do not want to be an organ donor, initial the other blank.”

“The second thing is about life support. It gives you three options, if you ever come to the point where you need a ventilator or other life support measures. You can leave that decision up to your agent, the person you designated on the first page. You can initial the next line to say that you do not want life support if you have a condition that is considered incurable or irreversible and expected to lead to death in a relatively short time. Or you can initial the third line to say that you want your life prolonged by any medically acceptable means, no matter the circumstances.”

“Lastly, the form asks for your wishes about tube feeding. If you ever come to the point where you are unable to eat or drink and need to receive nutrition and hydration through a tube into your stomach, for example, is that something you would want? It gives you the same three choices here, to leave the decision up to your agent, to say you don’t want your life prolonged by tube feeding, or to say that you do want tube feeding if necessary, no matter what the circumstances. Then you just need to write your address here and print your name below. But don’t sign it yet, because your signature has to be witnessed by two people. I can be one of them, but the other has to be someone not related to you and not employed by the hospital, so I usually try to find another visitor from a different room to do that. After that, I’ll make a copy of the completed form. One will go with you, to take with you if you’re a patient in a different hospital. It’s valid anywhere in the state. The other will go in your chart, and that will stay on file here at the hospital indefinitely.”

I’ve done this spiel so many times it’s like reflex for me. And sometimes I forget that what I’m asking can be distressing for  people. They may be in the hospital for a relatively minor procedure or non-terminal illness, and here I am asking them to think about, essentially, how they want to die. I can see it flash across their faces. I tell them it’s just a precaution, that we offer this to every person who checks in to the hospital, that I have an Advance Directive myself even though I am young and healthy. What I don’t tell them is that I’ve seen what happens when people don’t think about these things until it’s too late. I don’t tell them how agonizing it is for family members of an unconscious patient to try to guess whether their loved one would want to be on life support, when they have never had conversations like this with them. The time to think about these things isn’t when someone is dying. Then it’s too late and emotions are running high. It may seem counterintuitive, but it really does help to think about death while we’re still healthy. It’s one of the most basic ways I care for people as a chaplain.