6-Steps Advance Directive

is a small non-profit organization

6-Steps Living Will

P O Box 236

Edmonds, WA 98020

Director

Richard B. Stuart, DSW ABBP

Website designed and produced by Kayla Turner

The material presented here is offered without charge and with no expressed or implied warranty of any kind. Users should verify the validity of any documents they create with the help of this site. No personal information that you provide here will be shared with anyone else at any time.

 

 

Must we fear death?

 

Ever since the miracle of penicillin that cured so many bacterial illnesses, modern medicine has been promoted as a vehicle through which we can all defy death. I hate to be the harbinger of bad news, but the death of the body can be delayed but never denied. As evidenced in the growing prevalence of dementia, modern medicine has not been nearly as effective in delaying the deterioration of the brain as it has been in slowing the course of some terminal physical illnesses.

 

When brains falter, the senses of identity and purpose weaken, often to the point at which the essence of the person who inhabited the body appears to have abandoned the flesh and bones that was its shell. An image that comes to mind is driving a pickup down a lonely road with the tailgate open, allowing many cartons to slip off unnoticed until the driver reaches a destination and cannot make the intended delivery. Many people die before this happens and their families and loved ones can remember them as the vibrant, loving people they were. But others die in a state of not knowing who they are or ever were. Their survivors are left with the sad image of someone whose body they recognize but with a persona they never knew. When this happens, whatever it is that made life sacred has been lost. It is as if the body is an exoskeleton that the mind has abandoned. Medicine may delay, but cannot prevent this from happening.

 

Death is the mystery that has preoccupied humans throughout our history.

Some view death as the completion of the cycle of life, an inevitability that should be accepted and not feared. Lucretius, in his epic On the Nature of Things gave voice to the atomist position in this regard. He suggested that all matter, of which all humans and everything else on earth is composed, goes through an endless cycle of creation and destruction, and that nothing is ever lost since the atoms that that are destroyed in one form will always be rearranged in another. The Buddhist tradition offers a similar escape from the bondage of fearing death. Many Buddhists believe that what we conceive as self is merely an expression of part of the fabric of the universe and therefore cannot be lost at death. A famous parable describes a man who mistook a moving rope for a snake and became terrified by that fear in his mind. Upon discovery that it was only a piece of rope, his fear subsided and his mind became peaceful. The belief in an eternal soul is equated to the rope of that man's imagination. If this is your belief, you won’t worry about what comes after death but instead will concentrate on living your life to its fullest as an end in itself. Those who accept either the atomist or Buddhist views have no reason to fear death.

 

Others view the death of the body as the opportunity for the soul or spirit to ascend to a better place—or, as fate might have it, to descend into an eternity of torture. If this is your belief, and you're pretty sure you lead a worthy life, you, too, would not want to prolong the bondage of the soul to an ailing earthly body. This is the core message in Episcopal funereal hymn, "The Strife is O'er". Saint Paul suggested as much in the words: “we are always confident knowing that, whilst we are at home in the body, we are absent from the Lord” (in 2 Corinthians 5:6). You may also believe that when the spirit leaves the body, it may not go far, remaining in contact with loved ones in wonderful yet mysterious ways.

 

But many people do not share these beliefs. They fear death, view it as punishment, and cling to the hope that it won’t happen to them.  For them, the worst that life can offer—its pain and degradation—is preferable to death and they will endure everything that can happen. If this is your belief, you will pursue every possible treatment to prolong your life, and hopefully will try to buy extra time by doing ever greater good works.

 

In conclusion, death is what we make of it. We can fear it as a horrible condition and live in terror of dying, trying desperately to delay it at great personal and social cost. Or you can radically accept that death is inevitable, that you no matter how much you may not like the inevitability you can't change it, but if you are open the possibility, life can be meaningful in ways that you never imagined.     

 

A kind of death one might rightly fear.  

 

BLACK BOX WARNING

Although an increasing number of studies reach the conclusions summarized below, the technology used in the research is still in its relative infancy. Therefore the following material should be regarded as tentative and not yet fully validated. (References in the More Information Tab)

 

“Permanent vegetative state” exists when patients appear to be awake but show no outward signs of awareness of themselves and their environment. It can be caused by a prolonged period in which the brain did not receive oxygen, bleeding in the brain, and/or a disease that degenerates the nervous system. The brains of these patients are capable of sustaining breathing and heartbeat and cycles of eye opening and closing that appear to simulate sleep. The patients show no ability to control any bodily function or to communicate in a meaningful way. Until recently it was believed that the persona of patients in this state ceased to exist. Recent studies found that approximately 40% of vegetative patients have brain scans that show activity in networks that could support cognitive function and consciousness [and pain sensitivity] despite profound behavioral impairment that makes it impossible for the patients to overtly respond in any way. The longer a patient remains in this state, the less likely it is that he or she will regain consciousness.

 

No one knows for certain, but it is possible that patients in a permanent vegetative state live with intense pain and emotional distress with absolutely no way to communicate these facts or ask for relief. In addition, many of the patients’ families consider their state to be worse than death. As is true in all decisions about “pulling the plug”, there is a risk of waiting too long and prolonging patients’ suffering, or of doing it too quickly to permit reasonable recovery. Given the diminishing likelihood that patients will regain consciousness after an extensive  period in a vegetative state, professional organizations have shown a growing concern about whether it is ethically correct to prolong the patients’ lives by artificial hydration and nutrition and dialysis.