Subj: Re: 911 Prayer Requst Update
Date: 1/27/00 1:44:57 PM Pacific Standard Time
From: nebarry@earthlink.net (Barry Hofstetter)
To: Theonomy-L@dlh.com
CC: KEVIN4VFT@aol.com
----- Original Message -----
From:
To:
Sent: Tuesday, January 25, 2000 4:59 PM
Subject: 911 Prayer Requst Update
Kevin, first of all my prayers are with you during this difficult
time. I would like to share a bit with you (how's that for wimpy
evanjellyfish language, but seriously...) both from my personal
experience in dealing with the illnesses of all our parents (my
mother-in-law died 12/18 after a protracted illness), and also
professionally from my time as a hospice chaplain.
> Theonomy-L submission from KEVIN4VFT@aol.com
>
> Here's the latest on Dad. It may be a bit on the long side.
> I'm wondering whether we're doing the right thing, or
> whether we're committing some kind of euthanasia.
> On Saturday night dad's breathing became labored
> and by Sunday noon he was in miserable shape,
> I was scared and called 911. The paramedics,
> God bless them, said "It looks, tastes and smells
> like pneumonia." I was quite relieved. We had
> been giving him his daily cancer treatments for
> a month (five hours of infusions and 70 pills a day),
> and he had been steadily losing mental clarity.
> Whereas he had at first been eager to take his
> pills, even asking or reminding us about whether
> he was due for a dose, he became increasingly
> resistant to treatment, agitated and angry.
> Mom and I had to watch him full time, 24/7,
> to make sure that when he got up he did not trip
> and fall -- and he began getting up every hour,
> even through the night.
This level of care can be very difficult over a period of time. Is it
possible for you to have home health aids or other caregivers come in
and give you respite?
> In short, we were relieved and optimistic
> that a short stay in the hospital could clear
> up his congestion, get his days and night ordered,
> and give us time to rest up. We were totally
> exhausted.
As I suspected...
> After an hour wait in the ER waiting room, I decided
> I wasn't accomplishing much, and drove home to
> send out some emergency prayer request email,
> which you received. At first it said dad had pneumonia
> and it looked OK. But then my sister called from
> the hospital and said the doctors were giving us bad news.
> The first words spoken to my mom were "Do you
> have a living will? Have you made decisions about
> heroic measures?" We thought it was just pneumonia.
> My mom was certainly shocked by this legal "bedside
> manner." I sent out an "It looks bad" email motivated by
> near-hysteria and headed to the hospital
> About six hours later I saw dad and he was calm,
> peaceful, breathing well. I assumed again that he
> could be treated for pneumonia and we could resume
> the cancer treatments. I was a tad angry that lawyers
> were telling doctors what to tell family of patients.
Well, the lawyers are not telling the doctors this, but the doctors
and nurses have certain legal questions that they must ask a family
when they suspect that a patient may be terminal. They do it both to
protect the institution as well as the family.
> In the process of talking with the doctor in charge of
> my dad I discovered that my parents' will does not
> reflect their wishes. This is because lawyers and
> doctors don't know how to communicate. (Surprise!)
> A nurse friend of mine told me yesterday morning that
> my parents' will would get both of them tagged
> "DNR" -- "Do Not Resuscitate." This because of
> language in their will which says no to "heroic measures."
As I understand it, a will, living or otherwise, is not legally
binding in these cases. De facto POA falls on the closest living
family members, who may instruct the doctors to take whatever measures
are necessary.
> It's one paragraph of canned legalese. You insert the word
> "REQUEST" or "DENY" in the blank and the computer
> prints out the will. My mom and dad would have wanted
> "heroic measures" performed if they were short-term
> measures with the prospect of a resumption of life
> more-or-less like life the day before we called 911.
> Mom would have preferred to resuscitate Dad if his
> heart stopped or breathing needed help if those
> measures would have gotten him through a crises and
> we could then resume treatment for the cancer.
> What lawyers are thinking and what doctors are thinking
> are two different things, and both differ from what patients
> and family are thinking.
Do either of these words actually appear in the will? If *not*, then
the medical presumption is that heroic measures be used. Has the will
been notarized and appropriately filed? If it is simply a document
sitting at the house, then it is not legally binding. Now get this:
even if the word "deny" appears, the family may override the decision
simply be telling the doctors that the patient no longer (or in your
Dad's case, never really) feels this way. The presumption is that the
next of kin knows the mind of the patient better than anyone else, if
the patient is no longer competent to make decisions.
> We had hopes that the "alternative treatment"
> my dad is undergoing will cure his cancer.
> No illusions, but hope. The treatment has had
> remarkable success. We were quite impressed
> with their facility in Houston, and it isn't like
> going to a back alley in Tijuana for apricot pits.
> http://www.cancermed.com/
I am not going to critique or defend your treatment decisions. I do
encourage you to get as much medical advice as possible from competent
and accredited professionals.
> The doctor in charge of my dad is utterly
> unfamiliar with this alternative therapy, and
> assumes the treatment is medical quackery
> or religious hokum, and this informs his
> understanding of my dad's will, which speaks
> of an "incurable and irreversible" condition.
> He would not perform any "heroic measures'
> because he thinks my dad's a goner. We
> would have approved such measures because
> we're eager to resume his "unconventional
> therapy." We tried to describe this therapy,
> but the doctor had already placed us and the
> therapy in the "upper story" (as Francis Schaeffer
> called it). He gave us all kinds of irritating, syrupy
> platitudes like "We respect your right to believe in
> any way that makes you happy, and we want you
> to be comfortable with your beliefs." In other words,
> "You have the right to be stupid and to nurture a subjective
> warm fuzzy feeling in the New Age world of non-reason,
> no matter how unrealistic or even false, but I live in the
> real, scientific world of conventional approaches and
> tight budgets." But since he did not believe in the reality
> of our "upper-story," he would not let that interfere
> in *his* decision-making process.
He does not make the decisions. You, as the family members, make the
decisions.
> Bottom line: nothing would be done to cure
> his pneumonia, because his will said "no
> heroic measures." It's true that mom has
> the final word, but she and I are simply not
> strong enough to continue treating him,
> especially in the mental state he had before
> we called 911.
Contact the hospital's patient advocate. Chaplaincy might also be
able to help clarify matters and communicate your wishes to the
doctor.
> The next day things changed somewhat. We were
> told that X-rays showed that the cancer was strangling
> his lung, and that he didn't actually have pneumonia.
> Moments later a representative for the hospice program
> took us aside and gave us her pitch. "Make them
> comfortable." I really don't believe in the interminable
> process of machines keeping dead bodies moving.
> I like the idea of people dying at home without racking
> up hundreds of thousands of dollars of medical bills.
> I like the idea of making death comfortable. The
> hospice rep said that fluids make the body
> uncomfortable. Sounded good at the time, but as
> I think about it now, we're simply starving dad to
> death. I should say, "comfortably" starving dad to
> death.
It should be possible to arrange hospice at home. I know nothing
about the programs in your area. For patient to sign hospice, there
must be a doctor's order stating that the patient has 6 months or less
to live, and that no treatment has any reasonable chance of success.
The patient or POA must really agree to no life-saving measures (i.e.,
you don't call 911 or put the patient in the hospital regardless of
the presenting difficulty).
> As I write, mom and sis are at the bank doing some
> financial things, getting copies of papers out of the
> safe-deposit box, etc., and then we're going to the
> hospital, where I hear Dad is peaceful, calm, and
> in no pain, due to drip morphine.
> Pray for us while we're there. And if you'd
> like to pray that God will tell Dad to take up his
> bed and walk, that would be OK with us! :-)
Consider it done.
I just checked my information with my wife, who is a hospital chaplain
(and has also worked as a hospice chaplain) and she confirms my
understanding. A will does not supersede the emergency medical POA,
which defaults to the closest family member (in this case, your mom).
If you wish further information, both Shari and I will be glad to help
you as much as we can. My alternative email is:
nebarry@juno.com
Our home phone is 215 924-6595 (I don't mind putting that in email
since all one has to do is look it up in the phone book anyway!).
N.E. Barry Hofstetter
Husband to Shari
Father to Nathania, waiting for Jackie
Licentiate, Presbytery of Philadelphia
Member, Trinity OPC, Hatboro, PA
Ph.D. candidate: WTS
Old enough to know better -- sometimes!
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From: "Barry Hofstetter"
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References: <73.b94f17.25bf76c9@aol.com>
Subject: Re: 911 Prayer Requst Update
Date: Thu, 27 Jan 2000 16:42:29 -0500
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