1. PERSONAL VALUES, CULTURAL ASSUMPTIONS, AND RESPONSIBLE CHOICES IN LIVING AND DYING Approaching and Dealing with End of Life Issues

4. We Didn’t Used to Discuss This… What Changed? - the rise of thanatology in early 20th century - post-World War II reflection on death - Herman Feifel’s The Meaning of Death - advances in medical science & pharmacology - rising costs of health care, elder care, and funeral services. - collapse of a cultural values consensus

5. The attempt made in recent decades by secularist thinkers to disengage the moral principles of western civilization from their scripturally based religious context, in the assurance that they could live a life of their own as "humanistic" ethics, has resulted in our "cut flower culture." Cut flowers retain their original beauty and fragrance, but only so long as they retain the vitality that they have drawn from their now- severed roots; after that is exhausted, they wither and die. So with freedom, brotherhood, justice, and personal dignity — the values that form the moral foundation of our civilization. Without the life-giving power of the faith out of which they have sprung, they possess neither meaning nor vitality. -- Will Herberg,

6. Formerly Assumed Principles: Life is sacred and therefore a mystery Life begins with a heartbeat and ends with the cessation of a heartbeat Control of living and dying are beyond human power Individual life is part of a communal & family matrix Death is a rite-0f-passage to be formally observed Body burial is essential to proper dying & mourning

7. Having That Conversation…. 40 percent of hospitalized persons lacked the mental capacity to make decisions regarding their care; Indiana University Study: non-designated surrogates base their judgments on considerations other than what the patient wants; Golden Rule Concept: what would I want if it were me?

8. Having That Conversation… Designate a medical power-of-attorney who shares your values; Include all “stakeholders”: spouse, children, designated medical POA, financial POA, clergy/chaplain/spiritual leader. Acknowledge the emotional element of the conversation on end-of-life values and desires; Focus on the goal: directives that will bring comfort to everyone involved when the need arises.

9. IF IT ISN’T IN WRITING, IT DIDN’T HAPPEN. LAST WILL AND TESTAMENT (DUH!) FUNERAL PREARRANGEMENTS POWER OF ATTORNEY DESIGNATIONS LIVING WILL DNR/DNI ORDERS P.O.L.S.T. ORGAN DONOR (AS DESIRED) Get It In Writing!

10. “Post-mortem” Care Common questions posed: - What about cremation? - Should my ashes be buried? - What about organ donation? - Is it okay to donate my body for research? - Can there be a memorial service if I’m not there? (!) Prearrange with funeral professionals who will carry out your desires.

12. Power of Attorney Designation* A medical power of attorney is the advance directive that allows you to select a person you trust to make decisions about your medical care if you are temporarily or permanently unable to communicate and make decisions for yourself. This includes not only decisions at the end of your life, but also in other medical situations. This document is also known as a “healthcare proxy,” “appointment of healthcare agent” or “durable power of attorney for healthcare.” This document goes into effect when your physician declares that you are unable to make your own medical decisions. The person you select can also be known as a healthcare agent, surrogate, attorney-in-fact or healthcare proxy.

13. Living Will* A living will is an advance directive that guides your family and healthcare team through the medical treatment you wish to receive if you are unable to communicate your wishes. According to your Pennsylvania’s living will law, this document is considered legal as soon as you sign it and a witness signs it. A living will goes into effect when you are no longer able to make your own decisions.

14. DNR (Do Not Resuscitate)* A Do Not Resuscitate (DNR) order is a written physician’s order that prevents the healthcare team from initiating CPR. The physician writes and signs a DNR at your request or at the request of your family or appointed healthcare agent if you do not want to receive CPR in the event of cardiac or respiratory arrest. The DNR order must be signed by a doctor otherwise, it cannot be honored.

15. DNR Considerations* Can be cancelled at any time by letting the doctor who signed the DNR know that you have changed your decision. Remain in effect if you transfer from one healthcare facility to another. However, consult the arrival facility’s policy to make sure. May not be honored during surgery but this is something very important to discuss with your surgeon and anesthesiologist before surgery so your wishes are honored. Should be posted in the home if that is where you are being cared for.

16. DNI (Do Not Intubate)* Intubation is the placement of a tube into the nose or mouth in order to have it enter your windpipe (trachea) to help you breathe when you cannot breathe adequately yourself. Intubation might prevent a heart attack or respiratory arrest. Refusal of intubation does not mean refusal of other techniques of resuscitation. If you do not want mechanical ventilation (breathing), you must discuss intubation because it may be included as part of a DNR order. Even if you have completed a DNR order that does not mean that you have refused to be intubated. If you do not want life mechanically sustained, you must discuss your decision about intubation with your doctor. *National Hospice and Palliative Care Organization

17. P.O.L.S.T. www.polst.org http://www.polst.org/wp- content/uploads/2013/01/POLST-Form.pdf

18. What About that Values Thing? Erik Erikson and Stages of Psychosocial Development: Stage Seven: Generativity vs. Stagnation Stage Eight: Ego Integrity vs. Despair

21. PERSONAL VALUES, CULTURAL ASSUMPTIONS, AND RESPONSIBLE CHOICES IN LIVING AND DYING Approaching and Dealing with End of Life Issues