A draft of a Health Care Directive


(This is a draft of a Health Care Directive that I offer as a resource to you as you prepare your own directive.  Please make sure that you have this document reviewed by a lawyer from the jurisdiction where you live before using it.  Modifications may have to be made to comply with the laws where you live.)

HEALTH CARE DIRECTIVE

TO:     MY FAMILY, MY PHYSICIAN, MY LAWYER, TO ANY MEDICAL FACILITY IN WHOSE CARE I HAPPEN TO BE, AND TO ALL THOSE CONCERNED WITH MY CARE.

As a Christian, I believe that all human life is a valuable gift from God and is therefore worthy of protection, preservation and support.  In matters of human life, the Christian aim is always to care, never to kill. However, as a Christian, my hope and my goal is not contained within this life on this earth.  I look forward with anticipation to the glorious life after death in the new heaven and the new earth which Jesus will give to everyone who trusts in Him.

Therefore, I, __________________________________, being capable of giving instructions about my current medical treatment, make this Health Care Directive to be followed if I lose the capacity to make or communicate decisions regarding my health care.

PART I – Health Care Wishes

The following are my feelings and wishes regarding my health care:

If I am physically or mentally incapacitated and yet able to remain alive if basic health care and assistance with the basic necessities of life are provided, I would like basic health care and assistance with those basic necessities of life to be provided.  However, if I am physically or mentally incapacitated and there is no reasonable expectation of recovery, and especially if I am at or near the age when one would normally die, I would ask that heroic means not be used should a life-threatening event occur.

If I am physically or mentally incapacitated and require heroic means to remain alive, I ask that those heroic means not be used and that I be allowed to die.

If the situation should arise in which I am in the irreversible stages of death, I wish to be allowed to die and not be kept alive by artificial means or heroic measures.

I particularly want to have the following health care:

If I am in the irreversible stages of death and in pain, I ask that medication be administered to me to reduce or alleviate my suffering even though the medication may be addictive and may unintentionally hasten the time of my death.

I particularly do not want the following health care:

If I am in the irreversible stages of death, I do not wish to be kept alive by artificial means or heroic measures, nor do I wish any treatment which would be termed experimental.  Also, if I am without mental capacity and in the irreversible stages of death, my proxy may direct that all artificial life supports be removed.

The following are thoughts that I feel are relevant to my instructions:

I believe assisted suicide and euthanasia both violate the Fifth Commandment, “You shall not murder,” and are therefore wrong.  Yet, I also believe that a person should not be allowed to suffer needlessly.  I believe that God has given us the gifts of medicines, medical people and medical technologies to use to reduce suffering and to enhance and extend life.

Each person, no matter how infirm and socially useless he or she may appear to be, deserves to be accepted as a being created in the image of God.  Therefore, if I am physically or mentally incapacitated and yet able to remain alive if basic health care and assistance with the basic necessities of life are provided, I would like basic health care and assistance with those basic necessities of life to be provided.

Here are some examples of what I mean by the terms “assistance with the basic necessities of life,” “basic medical care,” and “heroic measures.”  Because food and water are necessary for life, I consider the use of a feeding tube to be providing assistance with the basic necessities of life.  I consider the administration of antibiotics to fight an infection to be basic medical care.  Because the use of a respirator or a defibrillator is a significant human intervention without which a person would immediately die, I consider such things to be heroic measures.  If I am in the irreversible stages of death, such heroic measures would artificially extend my life beyond what God would otherwise allow, therefore, under such circumstances, I wish that such heroic measures not be used.

I recognize that, unless Jesus comes back first, there will come a day when my life on this earth will come to an end.  As God’s Word tells us, All the days ordained for me were written in your book before one of them came to be (Psalm 139:16b) and There is a time for everything, and a season for every activity under hearven; a time to be born and a time to die, (Ecclesiastes 3:1-2a).  Therefore, if I am physically or mentally incapacitated and require heroic means to remain alive, I ask that those heroic means not be used and that I be allowed to die.  Also, if I am in the irreversible stages of death and heroic measures are required to keep me alive, I ask that those heroic measures be withdrawn and that my life be allowed to end as God would have it happen.

The questions to ask are these:

1.         Am I dying and is there no hope of recovery?

a)         If yes to both parts of the question, refrain from heroic measures, manage the pain and allow me to die.

b)         If there is hope for recovery, use medical care, even heroic measures, to try to restore health.

2.         Am I mentally or physically incapacitated and are heroic measures required to keep me alive?

a)         If yes to both parts of the question, refrain from heroic measures, manage the pain and allow me to die.

b)         If heroic measures are not required to keep me alive, that is, if I am able to remain alive if basic health care and assistance with the basic necessities of life are provided, then provide basic health care and any required assistance with the basic necessities of life.  But if I am in such a situation and there is no reasonable expectation of recovery, do not use heroic measures should a life-threatening event occur and allow me to die. 

PART II – Organ Donation

If any of my organs or tissues are considered suitable for donation to any person or persons who may need them, I ask that all of my suitable organs or tissues be donated to others upon my death.  I have no further need of them and I hope that someone’s life may be improved or extended in this way.

PART III – Health Care Proxy

In the event my spouse, _____________________________, survives me, I appoint the following person to be my health care proxy:

my spouse, _____________________________.

In the event my spouse, _____________________________, predeceases me or becomes incapacitated, then I appoint the following persons to be my health care proxies:

my sister, _____________________________

Address

City Province Postal Code

Telephone number

my brother, _____________________________

Address

City Province Postal Code

Telephone number

my brother, _____________________________

Address

City Province Postal Code

Telephone number

and I Declare that the decision of any 2 of the  3 named persons shall be binding.

PART IV – Signature

Signature of Maker: ___________________________ Date: ________________

Address:  _______________________________

Social Insurance Number: _____________________

Health Care Number: __________________________

Witness: ________________________   Witness: __________________________ 

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About James Paulgaard

Living in the in between, becoming, but not quite there yet, old and new mixed together, hanging on with all my might to the One who is holding onto me.
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