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Advance notice

"Advance notice" Continued...

Issue: "Who will be the next pope?," April 16, 2005

"It used to be that when people couldn't eat or drink anymore, we knew the end was near," he said.

As Mrs. Schiavo lay dying, many Christians spoke up for a moral obligation to use feeding tubes to nourish all sick people. Their cries echoed a statement Pope John Paul II made in a March 2004 speech: "Administration of food and water, even when provided by artificial means, always represents a natural means of preserving life, not a medical act." In its introduction to advance directives, the Christian Medical and Dental Associations states: "Removal of a feeding tube should not be done with the intention of that being the cause of death."

Numbering our days

Christian hospice and end-of-life professionals suggest considering these things when discussing end-of-life wishes:

· The technicalities of state law: Much depends on understanding how a state defines terms such as "terminally ill," "persistent vegetative state" and "life sustaining measures" before signing a pre-made advance directive form. You might be agreeing to something you do or do not want.

· Quality-of-life values: Rather than considering treatments you don't want, talk about what the end of your life could look like. If you value spending time among churchgoers, with family, or outdoors, think of how your final days can allow for that.

· Cost: Hospitals increasingly have "futile care" policies that allow them to end life support when a panel deems it futile and a patient cannot pay for the treatment. If you want your family to pursue aggressive medical treatment at the end of your life, pre-plan for ways to cover the expense.

· How long you want to try certain treatments: Rather than ruling out any one treatment, think about how long you would want to try something before discontinuing it. Consider treatment such as CPR, ventilators, feeding tubes, and dialysis.

Resources for end-of-life planning

· www.cmdahome.org: Website of the Christian Medical and Dental Associations. Has a link to a living will kit.

· www.abanet.org/aging/toolkit/ home.html: The American Bar Association's living will kit. Includes scripts for how to talk about the end of life with family and friends.

· www.de.state.az.us/aaa/pdf/ adfhc.pdf: Arizona's approved living will form. Has a specific list of treatments you may or may not want, and in what conditions you would want them. A good checklist for someone in any state.

· Hard Choices for Loving People by Hank Dunn: Discusses the most common choices people with life-threatening illness face. Available at www.hardchoices.com.

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