Advanced Directives

Advance Directives: Controlling your future medical care

What medical interventions would you want to receive if you suddenly suffered a stroke that left you brain-damaged and unable to swallow – would you want physicians to provide you with artificial nutrition through a feeding tube? If you were injured in a car accident and unable to breath – would you want doctors to place you on a ventilator? If you suffered a severe heart attack and stopped breathing – would you want to be resuscitated?

These scenarios occur every day to people around the world. When these tragedies occur, the victim is unable to speak for himself and tell his doctor which treatments he wishes to receive or not receive.

Unless you have a written document to speak for you, your family will be faced with some very difficult decisions. If you prepare legal documents called “advance directives,” however, your family can be released from this burden. You can make your wishes known in writing, so that the burden of making these decisions are lifted from your family and you receive the exact care you wanted.

The path of Krishna consciousness is preparation for one moment – the moment of death. The most important preparation for death is the chanting of the maha-mantra: Hare Krishna, Hare Krishna, Krishna Krishna, Hare Hare/ Hare Rama, Hare Rama, Rama Rama, Hare Hare. But there are other preparations as well, to help make your death successful. In other words, there are practical steps you can take right now to ensure that at the end of this life, you will go back home, back to Godhead.

One of those practical steps is the preparation of legal documents called “advance directives.” Advance directives are so crucial in the United States that very nama hatta and bhakti vriksha group in the US ought to dedicate at least one session discussing them. If there is an attorney in your congregation who is qualified to speak on advance directives, you can invite that person to your class.

Advance directives are legal documents that give you some control over your future medical care. In the US, the most common advance directives are the “living will” and “health care power of attorney.” Most estate planning attorneys recommend both documents, in order to cover all situations.

A “living will” allows you to tell your health care provider what types of life-prolonging treatments you want or do not want. For example, your living will might discuss artificial life support, tube feeding, hydration, and resuscitation. Many states will also honor your wishes regarding organ donation.

A living will becomes active only when you are unable to communicate your medical preferences yourself. In other words, as long as you have the capacity to make your own decisions and communicate those decisions, you will be allowed to do so. Furthermore, a living will generally becomes active in only two specific circumstances: (a) you become terminally ill; or (b) you enter a permanent vegetative state. For example, if you suffer a heart attack, but otherwise do not have any terminal illness and are not permanently unconscious, a living will does not have any effect. You would still be resuscitated, even if you had a living will indicating that you do not want life prolonging procedures. A living will is only used when your ultimate recovery is hopeless.

If a living will is properly drafted and executed, it binds health care providers to its instructions. Find out ahead of time what your doctor's views are about advance directives and your specific wishes. If there is disagreement, you may wish to find a new doctor ahead of time.

A “health care power of attorney” is a second type of advance directive. It allows you to appoint a representative (“proxy”) to make health care decisions on your behalf in the event that you are unable to do so yourself. Some states call this document a “health care proxy” or “durable power of attorney for health care.”

This document gives your proxy a lot of control. The document does not expressly tell the proxy what to do. Therefore, you must have a lot of trust in this person. Your proxy must understand your desires, and have your best interests in mind. Your proxy should be well aware of the choices you have articulated in relevant documents, and should support those instructions. It is best to ask the person’s permission before appointing him as a proxy. You can explain your medical preferences and obtain his agreement.

Your proxy may need to argue your case with doctors or family members. Your proxy may even be required to go to court. Therefore, an assertive and diplomatic individual is preferred.

Whenever possible, name one or more alternate or successor proxies in case your primary proxy is unavailable. Preferably, do not name co-proxies, because it opens up the possibility of disagreement between them. If there is anyone whom you absolutely want to keep out of playing any role in your health-care decisions, you may be able to disqualify that person expressly in your document.

In Krishna consciousness, your life is a preparation for one moment – the moment of death. You hope to remember Lord Krishna at that crucial moment, and thereby gain entrance into the spiritual world.

It is crucial that you plan ahead for that moment. Your preparation should include preparing advance directives. You should appoint a proxy who understands the process by which Vaisnavas leave this world, and who will do everything in his power to make your departure successful.

Ideally, all preparations will be made. There will be a devotee on either side of you, reminding you to chant. You will be surrounded by devotees chanting the Holy Name. Another devotee will hold a picture of Radha and Krishna in front of you, so that your eyes can focus on Their beautiful forms. When the devotees see that you are about to leave, they will sprinkle Ganges water and Vrindavan dust on your head, and place Tulasi in your mouth.

In the United States, the law governing advance directives varies state by state. Therefore, nama hattas and bhakti vrikshas are the perfect forum for discussing these issues. Please talk to your local leaders and educate yourself. Do not leave this to chance.

Editor's Note for those who live within the United States:
Each state within the United States requires their own version of a Living Will/Advanced Directives. Please go to this link to click on your state and see a printable version of the document recognized where you live. http://www.caringinfo.org/stateaddownload

 
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