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George Washington on his death bed attended by family and friends

artist: Junius Brutus Stearns

George Washington on his death bed attended by family and friends


Bedside Manners

Putting Five End-of-Life Wishes in Writing


Let’s begin with the premise that we all have good intentions where our family is concerned. We want what is best for them, and we want to honor their wishes. Unfortunately, when it comes to end-of-life issues, many of us have not made it clear to our own families the desires we have related to our own care and decisions.

The best way to ensure this is for each one of us to fill out the Five Wishes document, which outlines all the important issues to be considered and decided upon prior to our death. The wishes consist of 1) the person I want to make care decisions for me when I can’t, 2) the kind of medical treatment I want or don’t want, 3) How comfortable I want to be (the choice often comes down to pain medications versus lucidity), 4) how I want people to treat me (how those final moments should play out) and 5) what I want my loved ones to know.

Rev. Deborah Kehle
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Rev. Deborah Kehle

Let me say this up front—providing your family with clear directions about your end-of-life wishes is one of the most loving, responsible, and caring things you can do.

As a hospice chaplain in Arizona, I often dealt with families who did not know or understand the wishes of a dying relative, because they were not spelled out in writing beforehand. I remember one instance where a son flew in from out-of-state when his mother was near death and unconscious. Because hospice services cannot include aggressive treatments, it was clear that the mother had chosen to go peacefully under our care. Sadly, the mother did not have documentation that reflected her wishes, and, as a result, the son—who had power of attorney on her behalf—removed her from hospice care and placed her on life support at a nearby hospital.

There are countless examples of this. When somebody is nearing death, family members rush in from around the country to be at the bedside. If things are not clearly spelled out in advance, the family will argue about use of pain medications, whether to honor end-of-life rituals or religious beliefs from one side of the family vs. another, whether to prolong a life utilizing various means of life support, and even where and how to bury the body. In the best of circumstances, death brings stress, sadness, grief, and even anger. When you add this added uncertainty and confusion to the mix, it can often make for major family conflicts and heartache.

Today I am proud to lead the congregation at Goleta Presbyterian Church. As a pastor, I feel it is part of my responsibility to tell parishioners, and anyone else who will listen to me, the tremendous value in clearly outlining end-of-life instructions for our families. The Five Wishes document is a perfect, easy-to-use template for doing this. I did it with my own parents, and it really helped to ease us into a conversation that I don’t think any of us were anxious to have.

I do believe that people are beginning to realize that there are significant consequences if you do not have a conversation about end-of-life wishes before it is too late, and the importance of putting those wishes in writing.

I recommend putting aside time to have the conversation and to fill out the Five Wishes document. Time and place is also important for this activity. Sometimes a less formal setting will allow the situation to be lighter and flow more naturally. Use the Five Wishes documents as a guide, and make sure to fill it out and sign it, if possible, during the course of the conversation.

Finally, may I implore you to do this right away? We all have the best of intentions for our family, but it is important that we be open and honest about these things while we have the opportunity. Here is a simple way we can turn intentions into reality now.

Reverend Deborah Kehle will be one of several speakers at the Alliance for Living and Dying Well Community-Wide Gathering and Celebration of the Five Wishes, taking place Tuesday, April 24, 5-7 p.m., at Rockwood Woman’s Club, 670 Mission Canyon Rd., Santa Barbara. For more information, call (805) 845-5314 or visit allianceforlivinganddyingwell.org.

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