Monday, January 05, 2009

Executing versus Engaging a HCD

At year's end, I noted many articles recommending execution of a health care directive or a "living will", as an important aspect of personal planning.

Engaging surrogate medical decisions in an end-of-life setting is more difficult than executing a document authorizing it.

The ramifications of a surrogate's medical decision, resulting in a patient's death, can last long and feel lonely.

In "Gwen was very lucky to have a friend like you" published in The Morning Call (Allentown, PA) on January 3, 2009, residual guilt was the subject. Such powerful feelings persisted in a questioner, despite a rational determination and a loving approach, which released a suffering friend consistent with her prior directions.

With permission granted by the columnist, Marc Gellman, I repost the question posed to him by a health care agent who fulfilled her role, but who still suffers anguish.

Gwen was very lucky to have a friend like you

Q: For 15 years, I held medical power of attorney for my best friend, whom I loved and respected. She was very sick for a long time and well aware that her time on earth was short. She even planned her own funeral and had a do not resuscitate order (DNR) in effect.

Many times, my friend stated that she didn't want to be tied to tubes. On one very horrible day, she choked and was taken to the emergency room, where the staff contacted me. When I arrived, the doctor informed me that they had worked on her for a while but couldn't keep her brain functioning and that it would be humane to let her go. I granted permission, and shortly after, she passed away into the arms of God.

Now, for my question ... I've always tried to live a life where you do not hurt another, much less agree that someone should die. For so many years, I fought to keep my friend strong and healthy, and I never gave up on her. Now, my soul is so heavy. I know I respected my friend's wishes, but my heart says I let her down and watched her die -- in essence, I killed her by not doing anything to save her.

Does God see me now as a murderer? How do I balance having medical power of attorney and honoring my friend's wishes with the torment my soul is going through? Most of all, how can I ask God to forgive me for letting her die?

-- Gwen's friend, via e-mail

The columnist's answer relies both on rational arguments and also on religious faith:
A: First, try to remind yourself that for 15 years you kept your friend alive. You helped her achieve a quality of life she would have never been able to achieve without you. At the end of her life, it was simply time for her to go.

It's important for you to understand that your friend was not dying when you received that phone call; she was already gone. Brain death is death, according to all medical and medical ethics guidelines.

Although you may feel like the catalyst to her death, it was God who took your friend, not you. Please let go of the burden on your soul. No one could have had a better friend than you.

The burden you feel now is not a sign of guilt, but rather a sign of love.
The column, entitled The God Squad, is syndicated through Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, NY 14207. The columnist can be reached at

Acting as a health care agent is challenging and fulfilling, but also painful for the sensitive person.

Capability to make decisions is one criteria for selection of an agent. Reliability to implement choices based on a patient's personal preferences is another criteria. Ability to accept the consequences of decisions made is a painful final criteria.