Joan Rivers’ recent, and sudden, death highlights the value of completing Advance Directives. Hopefully, her family knew her wishes for any time she was not able to speak for herself. Their end-of-life decisions, then, would be directed by Joan’s values instead of their own fears and feelings.

Advance Directives (AD) is the “umbrella” document that covers the following end-of-life choices:

• Healthcare Agent/Proxy or Representative – the most important element of AD, this decision names the person(s) that will speak for you if you are not able to speak for yourself. This person has talked with you, understands your wishes and values for end-of-life care and is willing to carry them out on your behalf.

• Living Will or Healthcare Instructions – this element of the AD names your wishes for specific medical interventions, such as: CPR or Cardiac Resuscitation, Intubation and Artificial Respiration, Artificial Hydration and Nutrition and Dialysis. Good pain management is always presumed in these situations, but can be added here as well.

• Organ Donation – should death be the outcome of the crisis, this AD decision gives loved ones a clear understanding of your wishes for organ donation.

• Conservator of Person – should the medical crisis result in long-term care and decision making, this element gives the loved one (usually the previously named Healthcare Agent) the authority to continue speaking on your behalf.

Different states have different language for these documents, so its good to learn more about local examples. Most are signed with witnesses in attendance, some with notaries, but attorneys are not required. It’s always advised to speak with your Primary Care Provider to understand these various terms and their importance in your particular circumstance. Another thing to remember – these documents can be redone at any time. Our health changes over the years and our goals for end-of-life care can change too. It’s important to look at this as a process, not as “once in a lifetime” decision.

During the first three months of Chaplaincy training, I realized how critical it is to have conversations with our families on this topic. If we don’t and a crisis or trauma occurs, they are left in a horrible position. They are hurting over the situation itself and they are being forced to make serious decisions. It is an act of love to have this conversation when we are healthy and clear-minded. We are giving our family a great gift.

And it’s never too soon. I brought the topic up the first Thanksgiving after I started Chaplaincy. My husband and I were in our 50s, with some health issues, but mostly fine and active. Our sons were in their 20s, active and healthy, one of them had experimented with sky-diving and bungee-jumping. Our conversation gave all of us permission to speak our wishes for medical care should we be unable to speak at the time.

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Lisa Irish

Lisa Irish, MEd, MA, BCC incorporates her experience in chaplaincy, spiritual direction and her own journey to guide the way in the Land of Loss. As former bereavement coordinator for Yale-New Haven Hospital and the Hospital of St Raphael, she ministered to individuals, groups and community organizations. Of her book, Grieving – the Sacred Art: Hope in the Land of the Loss, Fr. Richard Rohr says….”the roadmap is wise, but sensitive – grounded in hope – and reminds us to rest in God’s healing love.” Lisa shares her understanding of grief, healing and hope through rich retreat programs and in regular messages found at "Grieving with a Grateful Heart," Abbey Press. "Finding Healing in Times of Grief and Loss" (contributing author) Abbey Press "Grief - the Sacred Art," Skylight Paths Publishing in 2018.

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