Advanced Care Planning

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Topics: Job, Grace, Faith, Numbers, Ruth, Mark, Isaiah

Overview

Why Advance Care Planning Matters

When a faithful church member named Jan went in for what she described as a routine procedure to remove a cancerous portion of her lung, no one expected complications. Two days after surgery, she suffered an "event" and never regained consciousness. Her four sons—scattered across the country and assured the surgery was minor—had not come. Her oldest son held healthcare power of attorney, but no conversation had ever taken place about what she would want if things went badly. By the time the family gathered, decisions about ventilator, feeding tube, IV hydration, and transfer to hospice had to be made by sons who had never discussed any of it with their mother.

Jan's story illustrates why every Christian over 18 should do three things: think ahead, choose a healthcare agent, and have an actual conversation with that person. A document alone is just paper. The point is not merely to predict every possible scenario—none of us can—but to name someone we trust and to give them a framework for deciding well. For younger, healthy adults, this may be as simple as naming a spouse and a backup. For those facing chronic illness or advanced age, the conversation expands to questions about CPR, DNR orders, artificial nutrition and hydration, palliative care, and hospice. In every case, the gift to our families is clarity, peace, and reduced guilt.

The Church's Stake in This Conversation

Healthcare has always been the church's business. Jesus spent much of his ministry healing Mark 1:32-34, and the prophet declared, "by his stripes we are healed" Isaiah 53:5. Most hospitals were founded by Christians. Yet as medicine has grown more complex and impersonal, the church has often stepped back from these conversations precisely when families need them most. We have a message medicine cannot give: that life and death are held in God's hands, that this world is not our home, and that nothing—not life, not death, not anything in all creation—can separate us from the love of God in Christ Romans 8:38-39. Our work with one another doesn't end when medicine reaches its limit; it continues all the way home.

A Framework: The Best Interest Standard

Rather than trying to script every future medical scenario, consider telling your agent: "Do what is in my best interest at the time, and always remember that my home is in heaven." Research shows even close family members guess a loved one's specific wishes correctly only 60-70% of the time—partly because we ourselves don't know in advance what we'll want. The best interest standard frees your agent to make wise, prayerful decisions in the moment, in consultation with doctors, without the burden of guessing. Christians can let nature take its course in good conscience; we can accept pain medication that prioritizes comfort; we can recognize that suffering is not the worst evil and death is not the final word Philippians 1:21-23. We are not advocates of "death with dignity" as the world frames it—death entered through sin and is an enemy (Romans 5:12; 1 Corinthians 15:26)—but we are people who can face it without fear because Christ has already conquered it.

Practical Next Steps

Choose your healthcare agent (and a backup). For most adults this is a spouse, then an adult child or trusted friend.
Have the conversation. Thanksgiving weekend, when family gathers, is an ideal time. Tell them what matters most to you and remind them they are forgiven if a decision later weighs on them.
Put it in writing. Most healthcare systems provide free advance directive forms. Keep copies with your agent, your doctor, and somewhere accessible (some carry a photo on their phone).
Revisit it. Needs change with age and health. A 30-year-old's plan looks different from a 90-year-old's.
Watch out for one another. The church is family. If something doesn't add up about a brother or sister's care situation, speak up. We are here to bear one another's burdens Galatians 6:2.

Whatever decisions come, remember: you are forgiven, you are held, and your home is secure. That is the deepest advance care plan any believer has, and everything else flows from it.

Transcript

doing advanced care planning. I think I know most of you, but I'm Pastor Tim Rairson 1s

from South Dakota. I am on a statewide task force to try to increase the number of people 9s

who do advanced care plans. And the reason why we're involved with it is if you do this 14s

you get better health care. I mean that's the bottom line is you get the health care 20s

that you really think you need and we don't do extra things that we don't think we need. 26s

So it's both the health system sides and on the people's sides it's better for both 31s

groups. The only reason I'm on this task force is I have a member who was the dean of 36s

a nursing school and this nursing school was trying to put this together and promote 42s

it and all that kind of stuff. South Dakota we have two major health systems. Of course 46s

you know and these are huge self systems. Riley was a little town about 25,000 and they 56s

have their own health system. It's about 25 bed hospital as a clinic. It's just a small 63s

little group. But the idea is how can we improve health care down the road. And one of the 70s

ways to do that is by having conversations. So tonight is about how do we as a church, 77s

how do we as individuals help express what we want and talk about things in terms of the 83s

future. Now most of you know right we've been having class all week. Other students there 89s

have been really thankful. These guys and others have already been sitting in on class all 94s

week and joining us and it's been really good. And we're thankful for it. Steve and others. 100s

So let's start tonight with prayer. Your father and heaven we're thankful for your plan. 105s

That years ago before we were even created you decided that we would be yours. 110s

That while we were at centers you sent your son and died for who died for us. Help us to think 114s

about what the future holds and mostly that you hold the future. Give us wisdom and understanding. 120s

Give us of your spirit again. We ask this in Jesus name. Amen. I'm going to watch this right 128s

of a turn down. Now I'm getting used to it. So I got glasses and hearing aids and then on 134s

Sunday I wear this thing and a Garth Brooks or wherever I am. And all right we're going to begin 139s

with a case. So did you get sheets from Kerry? Pastor Maloneck. There you go. We'll start with 147s

a story. Jan is a 68 year old heavy smoking diabetic widow and she had an event two days following 155s

surgery to remove a cancerous portion of her lung. She has not regained consciousness in surgery. 162s

She's on a ventilator feeding tubes and IVs. All right we understand what's happening so far. 169s

Jan has four sons in their 40s they live across the country who are not there for surgery. Not a 177s

single one of them because it was according to Jan's understanding of the surgeon that the surgery 182s

was supposed to be pretty straightforward and a no big deal. They expect her to go home after 187s

10 days, the two weeks after a week or sons arrive at the hospital. The question is how do you help them 194s

deal with what has happened and what should be done now? 203s

Do you have questions about the case? Now this is a real life case. Jan was a member of our congregation. 213s

He paperwork at home once you can't answer you. I'd been digging through her desk drawer to see 228s

if there's any kind of paperwork that she had that they didn't know about because sometimes we 234s

don't share that information. Yeah no she didn't have any other paperwork. She had designated the 238s

eldest son, I think he's the eldest son. The eldest son to be her healthcare power of attorney. 244s

The youngest, not the youngest son, maybe the third son lived with them with her but he had gone off 253s

to the war and never quite came back. If you know what I mean. He's living with her but he's not 259s

able to make any decisions whatsoever. He needs to be taken care of. In fact he's now going to live by 266s

his brother who is a high school teacher out in Cheyenne, Wyoming. Casper, I mean. 272s

One of our four sons is out of the picture. One of our four sons is not making decisions. 286s

Okay so that would be three left. But they all came together. They're including their brother who 293s

asked some challenge. He won the decision to make and the oldest one is the one who will finally have 299s

the make the decision. The oldest one. Okay so the level of knowledge about the case since they 303s

worked there for the surgery would be really important. Do we know that level of knowledge? 309s

Oh yeah I can't point it this direction. Oh whoa. Sure so what's his level of knowledge 315s

about his mother's case since he was not there for the surgery? So the mother's knowledge of the 324s

surgery and I talked to her at a head of time. The mother's knowledge of the surgery was pretty 329s

straightforward. Not that big a deal. We're taking care of it. I had that same look on my face that 335s

you have because this is removal part of a lung and on top of it it wasn't done at the regular 342s

hospital. It was done at the specially heart hospital. But okay this is what she understood. This 348s

was her took her down for the surgery. It's about 30 miles away. He stayed there for a little 359s

bit and then he left out the surgery and done. Make sure he's okay. She's there and then has two 365s

days later an event. And that's literally what the physician called it an event. 371s

Do we get more information about the event? It seems to be some sort of something like a stroke 383s

or something. I went down the first afternoon after surgery just to see it. It's 50 miles away 389s

from me. I went down that afternoon to see what's happening. You know there's nobody around to 397s

talk to. You know I just sat in her room and prayed she can't respond at this point. 401s

I visited the nurses for a minute and I went home. I went down the next day same thing just go 407s

say hi. See what's going on. I get to the third day and the nurses say there's an event. 412s

Now can the nurses talk to me? They can with a sign consent. Yeah okay there's no 419s

consign consent by anybody. So can the nurses talk to me? No can the physician talk to me? 426s

No. But I'm the only guy showing up. Too bad. Because the other four are ways out and they don't 433s

think that it's they've been told it's not that big a deal. But she's going to handle it. 440s

So did the nurses talk to me? Absolutely they talked to me. And did the physician talk to me? 447s

Yes we kind of blew apart that whole hippo thing and we just started having conversations. 452s

It's a patient before he and the operation. It seems to me if he said no big deal don't worry about it. 460s

Somebody was misled. Okay excellent point. So was she misled by the doctor or did she just flat 470s

out not understand? We don't know the answer to that. Actually I do have an answer for it 478s

a little bit but it seems like she just didn't understand what was going on or there's another 485s

option yet. She's going to do the surgery because she thinks she's going to do the surgery and even 490s

though she's been told the rest she's going to go forward with it. And so she's not telling her 496s

sons everything that's going on. So you know that's how confusing this is because she's the only 500s

person that was in with the doctor. There's not a second person to ask what was really set. 507s

Yeah Nicole. I'm wondering if you say oh I'm going to be in the hospital for a while but 514s

it sounds reasonable that they would come back but maybe not because if they have small kids 528s

and things then she may not want to impose on them so she just tells them it's fine. 534s

That's entirely possible. I mean we don't I don't know the details of this. 542s

She has a son who's got kids in her middle school. She's got a son in Colorado that has younger kids 547s

and then she had a son in Texas that played in a band and then she's got this son who went off 555s

the war and didn't quite come back. Had real alcohol and drug trouble. He's a great guy but he's 561s

just not going to be helping make these decisions. This was... 568s

I think it was three years ago. 579s

Yeah exactly. 585s

No no no no. 586s

The her oldest son is probably now about 43-44 or something like that. 590s

Yeah she's 67 right? Her youngest her oldest son is about 43-44. She kind of got started 601s

early in life but there's no husband. She divorced the first time and the husband she married the 608s

second time is now died. I don't want to take up too much time but just trying to gather a few facts. 615s

So the power of attorney you mentioned that if I'm not mistaken that was the oldest son correct 621s

right should have been there prior to the surgery. There's a reason for a power of attorney. 627s

But he wasn't. So now the hospital made a mistake the surgery made a mistake. 632s

I don't know. That would be the same as a derest type situation if I'm not mistaken. 638s

I mean you can't make decisions. 644s

You don't have to have your power of attorney there. 646s

No it's not. 647s

There's a... 648s

No so I fell off a bicycle one day. It wasn't going very fast. I did the Superman thing when 649s

right over the top of the bars and busted that elbow. 654s

Yeah I'd have to read the power of attorney. 657s

It's so close to power attorney for me. 660s

My wife was 450 miles away. She says should I come? I said no no I'm good and then I got through 663s

the surgery and I'm fine and they called her on the phone. The four boys kept calling in and 668s

then the nurse got nasty because who's the wife and all this kind of... 674s

Yeah. 679s

Thank you. 679s

If the oldest son had the power of the medical power of attorney would he not have known what her 680s

wishes would have been if something like that happened? 689s

Well her wishes were never to have this thing happen. 693s

Well I understand that but none of us have control over that. 696s

So if she gave him the power of medical power of attorney, 701s

wouldn't there be some kind of a discussion? 707s

Oh not necessarily at all. 710s

You know that just because you have a point in someone to be that person doesn't mean you had 712s

a conversation with them at all. 716s

And you keep trying to figure out what she wanted. 721s

If we haven't shared what we want done, the power of attorney is like any other piece of paper 724s

that I could hand you the... 730s

our budget. 733s

It doesn't mean anything else because you don't know what their feelings are, what they want done. 734s

Well okay but we do know something. 738s

She's a firm believer. 741s

She and I had communion before she went in. 743s

We talked about heaven. 746s

So there's nothing there. 749s

She also was a long-term member of Lutheran's life 750s

with many of you know of that group around here. 754s

So she's pro-life Lutheran active member of the church. 758s

Her sons are not nearly as active as they once were but 762s

you know this is not somebody out there on the fringe of things. 766s

This is somebody who was in church every time we had church. 769s

Well she wasn't afraid of dying. 776s

You guys are keep trying to figure out what she wanted right? 782s

Is that the right question? 787s

Is that the right question? 793s

What does she want? 794s

Now when do you head to next? 796s

Exactly. 803s

That's exactly right. 804s

And we can find out all the details we can which we don't know a lot. 807s

But what are we going to do now? 811s

Is it a group or an individual who stands before Christ? 818s

We all stand before Christ. 821s

Only one at a time. 822s

We're all standing before Christ all the time every day every other day. 825s

Well you mean we want to get to heaven? 830s

That's correct. 832s

And then Jesus says you're mine and we're not standing before him. 832s

No, no, no. 835s

He doesn't. 835s

But you want him so you know that. 837s

We need to know what she thinks. 838s

We need to know what she wants. 840s

Well she wants like the rest of this to be in heaven someday. 842s

Not that day but something to be in heaven. 846s

Well then you can't then that's her wish. 849s

She's already given it to you. 851s

That's not it. 852s

Right but what does that do with how do we now go forward? 853s

All right so here's the real challenge. 858s

Okay she's on a ventilator. 861s

She is on IVs and she's on a feeding tube. 864s

We got all this right? 870s

The doctor at some point the boys all come together. 872s

I don't know the sons. 874s

I know the mom but the sons have moved away and I'm the pastor. 876s

It's been there been there a long time. 879s

But they moved away before I got there. 881s

So I haven't ever really met them. 883s

So a guy from the church comes down with me. 885s

He happened to be he's kind of our head elder kind of guy. 888s

He also was their biology teacher. 890s

So he knew these kids growing up. 893s

He's known them all their life. 895s

So they have a meeting. 896s

The two of us go. 897s

The four boys are there. 899s

There are two doctors. 901s

A couple of nurses, a social worker. 902s

They're all in this room together. 905s

It could have been Joe's friends but it wasn't. 911s

And so the nurse the doctor, the palliative care doctor who actually was a 914s

thoracic. 920s

Is that right? 921s

Thoracic surgeon? 922s

I got the right term. 923s

But she was now a palliative doctor. 925s

She's not doing thoracic surgery anymore. 926s

She's doing this. 928s

Sits down with us and visits. 930s

And says here's the deal. 933s

She's not going to get any better. 936s

We're not sure exactly what all that happened. 939s

It's not necessarily anybody's fault or mistake. 941s

But something happened here and she's not going to get any better. 944s

What are we going to do? 948s

So she then starts talking about options. 951s

She is in a very high level hospital. 954s

And she doesn't need to be there anymore. 958s

Because there's not much they can do for her. 960s

So we're going to have to transfer her somewhere. 963s

Where are we going to transfer her? 966s

What are we going to do? 968s

Feeding to. 970s

What are we going to do with that? 971s

What are we going to do about the ventilator? 972s

Should we start turning it down? 973s

Should we start moving someplace else? 975s

How do you make these decisions? 976s

Is the question. 979s

Now, I mean, do you want the rest of the story right away? 983s

No. 986s

No. 987s

Right. 993s

And she laid them all out and she did, she was amazing position. 993s

She just laid them all out with a great discussion. 997s

Everybody kind of knew what was happening. 999s

Yeah. 1001s

If I'm ever in one of the four sons, 1002s

no matter what my relationship is with her, 1005s

I would want to find out what her level of pain or comfort is and find out 1008s

what we can do to make to maximize that before you consider the next move. 1015s

All right. 1021s

She's not dead yet. 1021s

No, she's not dead and she don't seem to have much pain. 1023s

She seems to be fairly just laying there. 1026s

Not much response. 1029s

Not much going on. 1031s

She's just laying there. 1033s

You all get the basic idea of what we're talking about. 1036s

So, I mean, the details here are not really the last important thing. 1039s

It's this is happened when he said, okay, now what is the next step? 1043s

Now, we had a discussion about what to do. 1048s

So let's just take feeding tube. 1053s

Feeding tube should we turn it off or off? 1057s

Or should we continue to feed her that way? 1059s

Now, she's a member of Lutheran's life. 1062s

Lutheran's life is historically said you cannot take away nutrition from anyone 1063s

because that would be like taking away from me. 1067s

I'm going to make it for quite a while before this is a problem. 1070s

Some of you won't make it as long like past your carry. 1074s

But I'm going to make it a while, but sooner or later, we're all going to have trouble. 1076s

So, can we shut off the feeding tube? 1080s

The doctor said, well, here's the deal. 1083s

Let's not take it out. 1085s

Let's leave it in and see where we're at enough for a couple days. 1088s

We're not going to put anything through it right now. 1090s

But let's see if she gets better. 1092s

She'd be okay for a couple days. 1093s

If that's all right with all of you, 1095s

we'll just kind of take this not get rid of it or not keep it. 1097s

We'll just wait and just see what happens. 1100s

Okay, there's that one. 1104s

Vennelator, what are we going to do about that? 1106s

This is of course pushing air in. 1108s

Doc says we can start weeding her off of it. 1114s

Let's just try that. 1117s

We'll turn it down a little. 1118s

We'll turn it down a little more. 1119s

Actually, turn it all over off and she could breathe. 1121s

It's fine. 1124s

We start breathing air. 1126s

So, that part work. 1128s

IVs, does she need the hydration? 1132s

Well, once you move the feeding tube, 1134s

it isn't someone important to have the IVs. 1137s

So, we'll leave it the port in, but we'll disconnect that. 1139s

And we're going to move her to a different facility, 1144s

which is called hospice. 1145s

And in this case, it's the other side of town, 1147s

but let's take it over there. 1150s

And the hospice facility has a, I don't know, 1152s

rooms as big as that over there. 1156s

And there's one room where she's laying and there's a room behind it 1159s

where the boys can take turns sleeping and just be with her. 1161s

And she loved. 1166s

Go ahead, say it's the Elvis. 1170s

And so, I go down there and the room would be cranked up 1175s

the pole volume and she's not responding at all, 1178s

but we're playing Elvis at the top of my level of compassion. 1181s

I come in and they turn it down because I'm there, 1189s

but that's okay. 1191s

So, that's what happens. 1192s

And she then dies about two weeks later. 1193s

You get the story? 1199s

I mean, this is not uncommon story at all. 1200s

The only thing that's in here that's a little weird 1202s

is that they didn't come, but they didn't know to come. 1204s

And whether it's because she didn't tell them the truth 1207s

or she didn't know the truth or the doctor didn't tell her the truth, 1209s

we find out later that her case was taken to the thoracic surgeon group 1214s

because the whole group didn't know whether they should do the surgery or not. 1220s

And they had to have a debate among all of them and was presented 1224s

to say, this lady's pretty sick, should we do this surgery, shouldn't we? 1227s

But I don't know that she knew that. 1232s

I mean, I have no idea. 1234s

Certainly no one else knew that. 1235s

Outside of the group. 1238s

The only reason we knew it is because that palliative care doc 1239s

had been in on the meeting and then told us about it later. 1241s

The point for the seat, well, go ahead. 1248s

I'm going to the slaver gas did. 1253s

This is a well-known hospital, professional hospital, 1255s

no advanced directives, no DNR, nothing. 1259s

So what you're saying? 1262s

She had no, she has an advanced directive. 1264s

Her advanced directive is my son is the one. 1267s

That's an advanced directive. 1270s

And the son, the oldest son, was going to make sure that he and his brothers 1272s

were in agreement before they did anything. 1276s

Which makes sense too. 1278s

No DNR. 1280s

No, no DNR, of course. 1281s

Because they didn't think it was that bad. 1285s

And actually she couldn't have had this surgery she had a DNR. 1291s

Hardly. 1295s

I mean, they're putting on her ventilator to go through the surgery. 1296s

Is that, am I getting it correct? 1304s

Yeah. 1307s

I mean, if she had a DNR and they're in that position, 1309s

she's only 67. 1313s

You know, she's not. 1315s

She only 67. 1317s

She needs to be fairly healthy. 1318s

I mean, she got her trouble. 1318s

She's keep smoking. 1319s

And she's diabetic. 1321s

She's a little big. 1322s

But, you know, 1324s

from her point of view, she wasn't that bad. 1326s

And I'm the pastor. 1330s

I'm not going to argue. 1331s

I'm just going to try to be with her and just kind of hang out. 1332s

The point of this whole story is, 1335s

things can go bad quickly. 1339s

And how do we, as a church, as people of God, 1343s

help those with things that go on bad quickly? 1346s

Now, should all four boys have been there? 1349s

I think if they had a clue that this was going on, 1351s

they'd have been there. 1353s

They love their mother. 1354s

There's nothing wrong here. 1355s

It's a fine family. 1357s

But they just didn't have any idea. 1358s

Okay, so in the meantime, what happens? 1360s

Somebody's got to be there. 1363s

I keep going. 1364s

Doctors a little hesitant to talk to me. 1366s

Nurses are more happy to talk to me. 1367s

That's just, 1369s

I'm not going to talk to them. 1370s

Way life is normally speaking. 1370s

And we got to get something done while we wait for the boys to show up. 1374s

And then I kept going back. 1377s

It's only 100-mile round trip. 1379s

There's no big deal. 1380s

Out our way, I drive all the time. 1382s

Go down, spend three hours, come back. 1385s

What is the church's role? 1389s

So that's the second part. 1391s

Why should churches be involved in advanced care planning? 1393s

Number one, healthcare is our deal. 1397s

All it's has been. 1402s

We did a Bible study with the students. 1404s

We read the Gospel of Mark in what was it? 1405s

20 minutes. 1408s

And looked at every last passage in Mark 1410s

in 20 minutes that had to do with healing. 1412s

And there are just tons of them. 1414s

Our Lord was out healing people all the time. 1416s

This is a big issue. 1419s

Isaiah 53. 1422s

You all know the verse. 1423s

By his wounds, stripes, whatever translation you're using. 1424s

By his stripes, we are healed. 1430s

This is a big deal. 1432s

Every hospital exists pretty well. 1434s

It was started by Christians. 1436s

Somewhere along the line, we walked out 1439s

and not been so involved. 1442s

The Christian church. 1445s

Now I mean the Christians are heavily involved in this system. 1446s

But the church itself hasn't been. 1449s

Secondly, life has gotten much more dramatic 1452s

in the hospital. 1456s

We got computerized, which means we aren't telling stories to each other. 1458s

The physician comes on in the morning and expects in the past that the nurse 1464s

would tell him all that happened last night. 1467s

I mean she'd write in the chart or he'd write in the chart or whatever. 1470s

But they'd also have a conversation. 1473s

And it only happens so much anymore. 1475s

It's all now typed in and they draw down a schedule 1476s

and we got to fit this category. 1479s

And then we just go forward and write. 1480s

And it's, you know, the information's in that system somewhere. 1485s

But it's hard to write red pen on a computer. 1489s

It's just tough. 1494s

So we got a more complex system. 1496s

We have more things going on today than we ever had before. 1499s

The hospital, everybody else actually Medicare, Medicaid, 1505s

insurance, all these people want you to have something as you walk in. 1508s

So what is your advanced director? 1513s

Now maybe she had thought about it in advance, but she at least lines somebody up. 1517s

An advanced director would have ever taken care of this issue? 1524s

You have an event after surgery. 1528s

What do you want done? 1530s

That's, that's too weird. 1532s

You just don't do things like that. 1535s

But above all, we have the message to talk about. 1538s

When we're trying about life and death, that's our business, right? 1542s

Medicine only goes so far. 1546s

We don't stop. 1549s

We keep going. 1552s

You know, medicine gets to a point and somebody's not there anymore. 1555s

You agree through it, but we're still here. 1559s

And the church is still here and we're still trying to help one another out, 1561s

even past all of that. 1564s

When is our work with a patient done? 1568s

It's a silly question, right? 1572s

I mean, just blot out silly. 1574s

We're never quite done. 1576s

Until that person gets to be in heaven, just like the person before them. 1577s

The thing about an advanced care planning, and I put this here, is it's a gift. 1583s

If you get your estate put together in advance, before something happens, 1590s

that's a good thing. 1596s

And your children don't have to deal with it so bad. 1598s

So in my particular case, my mother died 21 years ago, colon cancer. 1601s

Mom kept care of all the books. 1606s

Dad didn't. 1608s

Not that dad couldn't, but he didn't. 1609s

Mom took care of it all. 1611s

She didn't do real well. 1613s

When she died, and dad had no idea, we didn't. 1617s

We, my brother's and I, dad had no idea where all the bank accounts were. 1621s

Not even even which bank they were in. 1626s

Because they had moved from Michigan to St. Louis, 1629s

and they had CDs or TVP deposits, and they thought they had some in banks, 1633s

but where is that record that says this is the number and where it is? 1638s

And there is no list. 1642s

Do you have a list of all of your accounts someplace? 1645s

I'm getting about a third of you to say yes, 1650s

and the rest of us say, oh, I got that, what difference does it make? 1653s

I don't know, Lou, do you got a list of all the... 1661s

Yeah. 1664s

Oh, your wife is this. 1665s

Well, there you go. 1668s

Amen, brother. 1668s

I wouldn't have the passwords, the account numbers, I wouldn't know what all the banks are. 1682s

So, after this happened in our family, my dad, once a year at the end of the year, 1687s

sends to the three of us, I have two brothers, sends the list of the accounts. 1692s

He doesn't say what's in him. 1695s

Just here's the accounts, here's the numbers. 1698s

Nothing about passwords, of course. 1701s

But here's the basic thing, just so we have a basic idea. 1703s

My mom was a hoarder, not bad, but she had medicine that she'd moved with twice. 1707s

And this is Mondeye's in 97. 1717s

She had medicine that dad had a thought that was from 67. 1721s

No, because, you know, why throw it out? 1725s

You might need it someday or something, I don't know. 1727s

So, it's a gift to have that kind of set up. 1730s

The people that go to the funeral home and make the plan and get it done, 1734s

it's just a lot easier on everybody. 1739s

But what about this? 1742s

Have we made plans on this issue? 1743s

That's the question. 1746s

Have we made it easier? 1748s

If you do it, you actually get better care. 1749s

You get the care that you want, instead of the care that is coming after you. 1754s

Or, you know, and we all know that struggles of these days. 1760s

Physicians running more tests than perhaps we think they need. 1764s

But they, I'm not, I try to put the best construction on everybody. 1767s

Because I was topic, you were all topic, right? 1771s

What do your mom say? 1775s

If you can't say something good about somebody, 1776s

I think she said shut up. 1780s

But, you know, it's the same basic premise, right? 1782s

You just can't do this. 1786s

So, the doctors are trying to figure out what's going on, 1787s

but maybe that doesn't need to happen. 1789s

And maybe the treatment won't be any different anyway. 1791s

And all these kind of things have to be happening. 1794s

But finally, if you help figure this out in advance a little bit, 1797s

you can lessen the guilt on the four boys. 1801s

Because they're going to have guilt no matter what. 1809s

Do we have guilt every day? 1811s

We're not Catholic. 1813s

We don't do it really well, but we still have guilt. 1815s

Can I say that and get away with it? 1820s

I mean, you ask him. 1822s

They're really good at guilt. 1823s

We have days of obligation. 1825s

We have to go to church, right? 1826s

Remember some of this stuff? 1829s

Carey's going, yeah. 1831s

Adam, you were, yeah, part of that same crowd, yeah. 1832s

So, we don't, we're Lutherans. 1836s

We don't do guilt as well as they do, but we still got some of it. 1838s

What is advance care? 1842s

So, I put it on here. 1844s

There's a little chart thing. 1845s

Advance care is different depending on who you are 1847s

in your age group and your health. 1850s

So, if you take Adam and pastor, 1853s

Carrie, or this Carrie, they are about, I don't know, you guys about same age? 1858s

I would think so. 1864s

Close. 1866s

Close. 1867s

They're both about 28. 1867s

Is that correct? 1871s

Yes. 1873s

That's correct more than once. 1874s

What does advance care planning look like for them? 1879s

They just need to pick somebody, right? 1885s

I mean, they don't have chronic things that diabetes and heart failure 1888s

and all this stuff that's going on. 1891s

They're not worried about strokes and anything like that. 1893s

They're just in case something were going to happen to me really bad, 1895s

I need somebody to look out for me. 1900s

Now, who by definition will look out for them in the first place? 1903s

They're spouse. 1907s

You don't, I mean, you can put it on the document in your spouse, 1908s

but I mean, that's pretty straightforward. 1911s

In both of their cases though, they have younger kids. 1913s

You don't have a kid that's old, a baby yet to you. 1916s

Neither one of them do. 1919s

All right, so who would go to next? 1921s

Whoever they say, they got to appoint somebody. 1925s

Because it may go to their parents or they could appoint a sister or a brother 1930s

or they could appoint somebody. 1933s

That age group, all we really need to do in terms of advance care, 1936s

that's this first level here, it's just pick somebody. 1939s

But at some point, there's a hiccup. 1943s

You see the hiccup on the chart, heart attack, 1946s

I don't know, something happened along the way. 1950s

And now the line's going down. 1953s

And after a heart attack, you get back to the same level of functioning as before. 1955s

Maybe, but not after the second one. 1961s

And it keeps going down. 1964s

As you get more and more ill like this, then there are more and more questions. 1966s

She thought, Jan thought she was up here. 1972s

She probably was in here in the middle somewhere, and by the time this is over, 1975s

it's down here. 1978s

But if I'm 91 years old and a nursing home, 1980s

now the question about DNR becomes important. 1984s

Because we looked at her today. 1988s

Do you know what the percentage of people is that are in a nursing home that get better after CPR? 1990s

3%. That's 1, 2, 3%. 2003s

What happens in a nursing home when they do CPR? 2007s

They end up breaking the ribs. 2010s

And you know, these people are not able to get it quick enough 2014s

and to get restored to health fully at that rate is not going to be good. 2017s

On the other hand, those you're walking around, which all of you walk in this evening, 2024s

it's a different deal. 2029s

If you have CPR done in a hospital or you're right there, 2031s

chance of recovery is pretty good. 2034s

Not 100%, but it's pretty good. 2037s

It's certainly not as good as they say on TV. 2039s

Because on TV, you know, they always do it and they're always good and 2041s

everybody's fine. 2044s

But we all know TV is not real, correct? 2046s

Except, of course, 2053s

diners, driving, and dives. 2055s

That's real. 2056s

But the rest of it is not. 2058s

So why do advanced care planning? 2062s

First is to motivate individuals to think in advance. 2065s

Second on the bottom is to select a carol-helified healthcare agent. 2068s

Third is to give some basic goals of care to that agent. 2073s

In case of, here it says, severe permanent brain injury problems. 2077s

So when I went doing Superman off my bicycle, 2081s

I could have landed and caused all kinds of trouble. 2084s

All I did was break out some teeth, make it look like what's in the market. 2087s

So I've told you this already busted my arm, 2091s

but I was okay. 2094s

Was I wearing a helmet that day? 2096s

Actually, it wouldn't matter because where I hit had nothing to do 2099s

where a helmet would be. 2102s

I almost always wear a helmet when I'm basically, 2104s

but I got in about 50 miles from home when I was going 350 and I forgot it. 2106s

And I was going about five miles an hour. 2112s

Because if you're 50 years old plus and you weigh more than 50 pounds and you land on things, 2116s

it's a whole lot different than when you were five years old 2122s

and weighed 50 pounds and you bounced. 2124s

I don't bounce so well anymore. 2128s

All right, so you may have a conversation, 2130s

so carry on Adam, whoever they pick is the second person, 2133s

or even with their spouse, say, 2136s

in case of a permanent brain injury, 2139s

in case of something like this, this is what I'm about. 2141s

And that may be as simple as just remember, 2147s

my home is not here. 2149s

My home is in heaven. 2151s

I mean, it doesn't have to be a fancier than that. 2153s

Right? I mean, just simply as simple as, 2157s

don't say to the doctor, do everything you can to save their life right now. 2159s

Do as much as is possible, but you know, at some point, 2165s

there may be enough as enough. 2168s

That's their age group. 2172s

Okay. 2173s

Who's in my age group? 2175s

I know you're a little older than I am. 2178s

Yeah, Steve and I are too far apart and Lou. 2181s

What should be done in our age? 2186s

So Lou just got welcome to Medicare. 2188s

Steve got welcome to Medicare. 2192s

I got five years before I hit welcome to Medicare. 2194s

What in our age group should be done in terms of advanced care planning? 2199s

I'm not sure that it's any different than there. 2204s

We're basically healthy. 2208s

Things are going pretty good. 2209s

You got to pick somebody. 2211s

Now, in loose case, you have three children. 2213s

So your healthcare agent is probably your wife first 2216s

and then probably your son Ben. 2219s

Because of his two sisters or a little if he, no. 2222s

It's because Ben lives with him, works by him. 2226s

They're in business together. 2229s

They're farming together. 2230s

He's the closest. 2231s

Right? 2233s

And he's very sharp. 2235s

And he's not out to get you. 2238s

No. 2240s

Your case, oh, the young lady next to you? 2243s

So how can you be 65 when she's 35? 2246s

That's not right. 2248s

That's right. 2249s

It's called grace, grace of God stuff, huh? 2250s

Yeah. 2253s

You know how I got through life? 2256s

You can just see it right now. 2258s

35, yes. 2261s

Yeah. 2263s

Is that correct? 2263s

35? 2264s

Yeah. 2265s

Not so much. 2266s

39? 2268s

2269s

Oh, 29, I'm sorry. 2271s

So what do you need a teller? 2274s

Yeah. 2277s

Who's the second person after that? 2285s

All right. 2289s

So their twins. 2290s

One of them is four of them because they don't get any help. 2291s

All right. 2294s

I was going to say twins, they got one mind, so they can just do it together. 2295s

No. 2299s

I know. 2300s

OK, so that's that age group, right? 2302s

Planning isn't a whole lot different. 2304s

And you notice that Jim, man, would have fallen basically in this age group. 2306s

All right, I'm not going to pick on anybody for age from here on out. 2313s

Because it was OK fine, but I'm not going to do it out of that. 2317s

Say you are 95 and in a nursing home. 2319s

What would you tell them at that point? 2325s

The list might be very different, correct? 2328s

I don't want this done. 2330s

Please don't have them call the ambulance. 2333s

Please don't crush me this way. 2337s

I mean, that may be a whole different deal. 2340s

Or then the DNR comes in. 2342s

Or if I can't swallow anymore, please don't put a feeding tube in. 2345s

I don't want to have artificial hydration and nutrition. 2350s

I mean, those are the kind of things you would talk about at that point, right? 2352s

But what's the most important thing? 2356s

Who you pick and did you have a conversation? 2359s

Now, for the record, just because you had a conversation, 2367s

doesn't mean that everything's hunky-dory and life is simple. 2370s

We're going to look at it in class tomorrow. 2375s

But they really have done a lot of research on how well can a child or a spouse 2378s

guess the intentions of the other person. 2387s

And guess how many times they're right? 2391s

Somewhere between 60 and 70 percent is where they're kind of right. 2397s

The problem is, do I know what I want? 2402s

So I tell my daughter, Sarah, who's after Ruth, my wife, then comes Sarah. 2406s

This is what I want. 2411s

But do I really know what I want? 2412s

I want a warm place to sleep. 2414s

I want donuts in the morning. 2418s

It was great. 2421s

They brought donuts in this morning. 2422s

I want it to be basically okay. 2425s

And for my wife to call me every day if she's not here and I'm not there. 2428s

You know, some basic things. 2430s

But how do I know what I want down the road? 2432s

And if I end up in a situation that I'm not now, 2436s

so I'm paralyzed for some reason, how would I know what I want in that case? 2438s

All I want to know for sure is that Jesus loves me. 2443s

But beyond that, and my wife still loves me. 2445s

Beyond that, you know, it's hard to say. 2448s

So it's hard for the substitute to guess what I want because I don't know what I want. 2452s

I actually have a mug at home and it has eight sides to it. 2456s

And it says on there, my decision is maybe. 2462s

But I never really know. 2466s

But where we're going to go eat tonight? 2468s

I don't know. 2469s

Whatever. 2469s

Eating is important. 2470s

I don't know what I want to know. 2471s

You know? 2472s

Have a conversation. 2476s

Pick someone and have a conversation. 2478s

On the top of the backside, 2480s

there is this place called Gunnerson Lutheran Health, 2483s

which is in less cross-wisconsin. 2486s

You can look it up on this new thing called the internet if you want or whatever you want to do. 2488s

But they have a 96% rate of people who have filled this out. 2493s

It warms out. 2498s

Most of the people are in the healthy age groups and it's just pretty clean. 2499s

But they actually have people that help them when you're no longer as healthy. 2504s

And you're moving into chronic kind of things. 2508s

And talking it through. 2510s

And what's happened is people don't get treatments they don't want. 2513s

And it saves everybody money on top of it. 2516s

So Tom Brocaw did a report in the Ember Tom Brocaw and you see news. 2521s

He report on this thing a few years back. 2525s

It was on National TV and said, here's a place where it's actually working. 2527s

People aren't getting extra things they don't want. 2533s

They're getting what they need. 2535s

And the physicians actually have time to get to the things they need. 2536s

They're getting stuck on things that don't matter. 2539s

Let's do a little terminology. 2545s

An advanced care plan? 2546s

Could be anything that just talks about what's going forward. 2550s

Now, you can have a variety of advanced care plans. 2554s

They then would include an directive. 2558s

Adirective could be a living will. 2561s

What's a living will? 2563s

A living will basically anymore has two things on it. 2570s

The DNR that do not resuscitate and the artificial hydration and nutrition. 2573s

You can then add other things if you want on there. 2579s

But those are the two key issues that are tend to be on it. 2581s

You're looking at me with quizzing. 2586s

Yeah, no, we're good yet. 2588s

Okay. 2589s

We got it. 2592s

I mean, those are two biggest issues people want to know about. 2593s

And you could write some other things on that. 2596s

A durable power attorney for health care issues or a health care agent 2599s

is this person you pick and you better tell them. 2602s

Because it doesn't make any sense to pick somebody and not tell them. 2609s

So you guys have two kids and neither of them are here. 2612s

Know your daughters here. 2617s

Neither one of them are here. 2619s

So this is the tough question. 2625s

I mean, my dad who's in hospital today has my little brother. 2626s

My youngest brother is the health care person because he's the caregiver. 2631s

He lives about 70 miles away and he checks seven on a regular. 2635s

I live a thousand miles away. 2639s

My other brother lives a thousand miles away. 2640s

We'll get there as soon as we get called. 2642s

We're going right away. 2644s

But we're not there. 2645s

So Peter should have that responsibility and that right. 2648s

And it's very clear. 2653s

In my case, he is my wife of course and then my daughter. 2654s

My son's younger. 2660s

We don't want to get him involved in anything. 2661s

But that's a whole different issue. 2664s

Hold the plug. 2667s

I'm just getting a tooth taken out. 2667s

Yeah, pull the plug. 2671s

I'm just saying my teeth they got it. 2672s

Michael probably isn't up to this. 2675s

I mean, he just has challenges. 2676s

Nothing against him. 2679s

But this probably would never be anything he should do. 2680s

In fact, his sister already knows that when we're gone, 2682s

she will have to look out for him. 2686s

Nothing wrong. 2688s

He's a great kid. 2689s

He's got a full-time job. 2690s

He has so much money in the bank. 2691s

It's amazing because you don't know how to spend it. 2692s

But it's just all there. 2694s

But he probably will never be the one that the doctor would ever want to go talk to. 2695s

He's not incompetent, but 2701s

there's no way I'm making sense. 2704s

It isn't just quite the guy that you should be 2707s

visiting with. 2710s

My daughter is probably the best. 2710s

I don't know. 2715s

Have you ever heard, is this one allowed in Texas, allowed natural death? 2715s

You know, you're DNR. 2723s

I'm sorry. 2725s

I don't know all the details of it because I don't do that on a daily basis. 2727s

If you get a DNR now, it's two different ways. 2731s

DNR, 2735s

C-O-T, which I think we're the only state with this. 2736s

Continue other care. 2740s

And then you have DNR, AND, allowed natural death. 2742s

Okay. 2746s

Did you all understand that? 2746s

So here in Texas, she's saying there are two kinds of DNRs. 2747s

And I know other states are having two kinds. 2751s

The initials might be different. 2753s

DNR, don't recessive date, but continue other treatment. 2755s

You're good. 2758s

You're good. 2759s

Yeah, I'm on here, I think. 2759s

And then, 2761s

and then there's a DNR that says allowed natural death. 2762s

And I think we've got new regulations around making sure that the informed consent 2767s

before the DNR assigned has been really done. 2773s

Well, a couple people have to sign. 2776s

Well, and that's the a thorough explanation of what this all is and what you're talking about 2779s

and all this kind of thing. 2784s

Do you have to have a DNR slip sign? 2785s

If you have a healthcare agent, you don't have to have a DNR, right? 2788s

Your healthcare agent is the one that will be involved. 2793s

These, you don't, we don't have to have DNRs. 2796s

You have to have somebody appointed to take care of you. 2799s

And actually, I'm sure in Texas, Illinois. 2802s

So yeah, you're not, I mean, 2804s

You don't say who will take care of you if you don't know. 2806s

There's such a thing, because it's called an out of hospital DNR. 2809s

If you don't, if you come in with nothing, you're not a DNR. 2812s

You know, you're automatically full code. 2815s

But if there's something called an out of hospital DNR that people have sometimes when they're 2818s

in nursing homes and I know our palliative care people are always complaining that the 2822s

nursing home forgot to bring the out of hospital DNR. 2827s

And here's now, we're now dealing with forms and paperwork. 2830s

So you sign in one healthcare system and their computers aren't matching with the other healthcare system. 2834s

And you know, I'm in Texas right now. 2839s

None of this is my healthcare system, which is up north. 2843s

Even though my insurance goes everywhere, but how does this all work? 2846s

That's why having a person is the most important thing. 2851s

I know when my husband was in hospice at our home, 2854s

we had to post on the wall a DNR. 2858s

So if Robin came to visit me and goes, he isn't a breathing, 2863s

that she didn't call the 2866s

paramedics to come and do something. 2870s

So we had to stop the go to wouldn't have to do that. 2871s

But yeah, every state is different on all this stuff. 2873s

Which are Canadian friends are having trouble understanding that every state in this union is different. 2877s

We all have 50 different laws. 2882s

Because they have just one law and it comes directly from the queen. 2884s

Yeah, I thought I'd wind it up again and keep them moving. 2890s

So if you go down the list, we all know what CPR is, right? 2896s

Chest compressions, breathing in the mouth. 2900s

DNR, we've talked about that. 2904s

Artificial nutrition and hydration, you all know what that is. 2906s

And it is some sort of artificial way to get stuff into you. 2910s

At what point in life is that no longer necessary? 2914s

When your body is shutting down and it isn't working right anymore. 2921s

So if your kidneys aren't working right and your bladder is not working right, 2925s

to get the fluid off of you, you have congested heart failure and it's not pumping right. 2928s

At some point, putting extra fluids in is not a good idea or extra nutrition. 2933s

Palliative care is a big title. 2943s

Any of us could use palliative care right now. 2945s

It is just caring for people who have chronic stuff and taking care of pain management. 2949s

Hospice is a little tiny part of them. 2954s

Hospice though is we've now changed the goal of treatment. 2958s

The goal of treatment is no longer cure, but it's care. 2961s

Actually, palliative care tends not to be the cure people. 2966s

They tend to be the care people. 2969s

But you could have a palliative care doc where you're still going through surgery 2972s

for something or whatever because they're dealing with your chronic pain while the other 2975s

doc is trying to fix whatever it is that's wrong inside or whatever it might be. 2980s

I got that right. 2986s

She's going to ask. 2988s

I just want to put a plug for the palliative care because like, 2989s

well, we have a palliative care full-time doctor now and it's really good. 2995s

And she sees lots of people who are, you know, they don't have to be on hospice, 3002s

to be seen by her. 3009s

And you know, I've seen her do amazing things. 3011s

Like she's the one who does all the talking and the connecting everybody. 3014s

So she's so bit so good for that. 3019s

And I've seen her do things like we had a patient in his 20s 3022s

dying from HIV related things. 3029s

Mom didn't know that he had HIV and he's dying and so she was able to kind of arrange for 3033s

getting mom there. 3041s

So that and that's the kind of stuff that I've seen them do. 3043s

It's more than just let's fill out the forms. 3046s

So I mean, if if if if Jan had had palliative care, usually palliative care doesn't come in 3048s

pre surgery unless it's something that you're really expected not to wake up from but 3057s

they're really good. 3062s

And they do, like you said, a lot of stuff beyond. 3063s

And she they know all about like the stages of dying and what pain relief to do and you know, 3065s

it's really can be a very good thing. 3073s

The palliative care, if you're in a place where they have it, which you guys say you do, 3075s

where I'm at in a little town, we don't have a palliative care doctor. 3080s

We just have doctors who just do what they've always done. 3082s

And in some ways, palliative care is what doctors used to always do. 3087s

And they're just, you know, they're caring for their patients, making sure they're okay and 3091s

comfortable. But you know, in a bigger place, palliative care actually tends to be a teen. 3094s

So social worker, a nurse, chaplain, a variety of people pull together to get all the resources 3099s

they can to help. 3106s

So we're good so far. 3111s

I put on here, so I use this form with the folks back home. 3113s

I put on here a website that it has to do with our hospital system. 3117s

But you can go to anybody's hospital system and they have all the form. 3121s

And actually, I've never used one of their forms. 3126s

When we were in the region, our will for our family, because my daughter was 26 and she wasn't in 3128s

there yet. We figured it's about time. We put her in the will. Our all-err will said, 3133s

if in case someday we have kids, we figured by now. Actually, 3138s

actually, my wife was on my daughter's case because she has kids and she needs a will. 3144s

And then Ruth looked at ours and said, whoops. 3148s

So while we were there, it didn't cost anything extra. I don't think we fill out the piece of paper 3152s

that listed healthcare proxy. 3157s

We just one more piece of paper and all those pieces of paper. 3163s

Back to the church site. Why is this important? 3169s

You know the him? I'm but a stranger here, having his own home. 3172s

This isn't really where we're going to live forever, deep in the heart of Texas. 3176s

Or wherever, mainly we're living. I mean, even if you get to paradise, which they call South Dakota, 3180s

you're not going to be there forever. 3185s

The great thing is in South Dakota, we don't have the problems you have. 3191s

Life is simpler. I have a brother-in-law who calls it Mayberry. 3195s

Because it's just, you know, it's just kind of quiet and you know, it's kind of that they own. 3200s

All it counts. We've heard of meth, but it's not, yeah. 3206s

Meth is a big problem in South Dakota, but it's not where we're at, 3210s

out on the reservation. And there it's a huge problem. 3212s

So this isn't our home long term. Where is our home? 3216s

Heaven. We do not believe in death with dignity. 3223s

Death with dignity is a slogan put out by those who are trying to say that death is okay. 3227s

Is death okay? No, we were created to live. Why did death come into this world? 3233s

Because some guy by the name of Adam. Maybe not that one. 3240s

But some guy by the name of Adam stood there quietly, right? 3247s

Where was he when that was all going on? 3251s

Right next to her, right? Adam wasn't out for a walk that day. He was right next to her. 3255s

He's supposed to be the one saying, hmm, that's an interesting idea. 3262s

He's wife's having a conversation with, 3265s

say, and that's always a good idea too. And then they take this fruit and they, 3269s

what did Satan say? Did God really say? What was the answer? 3275s

No, the answer is, I don't know, but he'll be in here about, I don't know, a couple hours. 3279s

He comes in every afternoon. Let's ask him. I mean, it was a simple problem 3284s

that they screwed up on. But because of that, we have death, correct? It wasn't God's idea. 3288s

Are we created to live? Yeah, if you ever watch somebody, that will to live is deep down inside of us. 3296s

And it's God given. But we're going to have to go through it. 3303s

And maybe we want it to be as calm and as peaceful as possible. Yeah, I get that. 3310s

But it might not be. 3315s

We don't know, right? 3319s

Yeah, I wasn't calm and peaceful as for Jesus. And I've certainly been around people that 3326s

wasn't calm and peaceful for. There's fighting over their everlasting breath. And others, it's like, 3331s

oh, okay, it's calm and it's pretty straightforward. It's okay. 3337s

Why is one that way and why not the other way? 3345s

The fancy German word is, it's white snake. 3349s

You know these German words? It means I have no idea. I just don't know if I see. 3353s

She does at home or what? 3366s

Do we want every last thing done? 3372s

No. Well, I have to say, probably answered, yes, but it already happened. 3377s

Correct? Every last thing that's important has already been done. 3385s

Now, does the doctors, the nurses, the hospitals, and I'm not blaming them at all? 3389s

Do they have to do every last thing in order to make sure I'm okay? 3394s

No, I'm okay. God took care of me. 3399s

Does that mean we reject medicine? Of course not. 3403s

They put my arm back together again. I got a tea plate in here because my name's Tim. 3405s

That way when I walk through TSA, they can, to Tim, it's right here. You can look at it. 3410s

Correct? Where they fix all kinds of things. 3415s

Where the dentist made this look pretty good. It doesn't look like Arkansas, does it? 3419s

It's actually pretty good. So we're in favor of all this, but is this the answer? 3422s

I love TV commercials. You take this pill and it will save your life. 3431s

And what do you scream at that TV or at that point? 3437s

Where did you save it? 3443s

We're already saved. Absolutely. 3446s

On top of that, you aren't saved my life. You may be delaying the hour of my death, 3449s

but that's about it because no pill is going to save me. 3453s

Now, our pill is good things. 3459s

Yeah, my blood pressure used to be too high, but my blood pressure these days is right on. 3461s

And it's because I lost so much weight. 3468s

No, I think it has to something to do with the two little pills that I'm taking every night. 3472s

So I'm on favorite because my blood pressure right now is 117 over 80. 3477s

And it used to be like 140. So are we favorite this? 3484s

Sure. But does every last thing have to be done? 3487s

I'm a big big fan and now I'm going to start doing promotions of it even more than I am. 3494s

Of what's called the best interest standard. 3500s

You kept asking me, what did she want done? 3504s

I really wanted to say it doesn't matter. 3508s

What matters is what's the best thing for her right now. 3512s

Because she couldn't have told you up front what was going to happen if this was going to happen because she 3517s

had no idea what was going to happen. And even the physician had no idea what was going to happen. 3521s

And the surgeon for sure had no idea what was going to happen or they wouldn't have done any of this stuff. 3525s

They would have said, no, this is too risky. We shouldn't do this surgery. 3530s

You should just stay home. You got cancer in your lung. Okay. 3533s

But you're going to have some more time if you just don't deal with it through surgery. 3539s

Nobody could see what was going to happen. 3544s

The best interest standard is you ask that person to do what is in the best interest of that 3547s

of the patient. So I talked to my daughter and say, I'm not sure what's going to happen in the future. 3555s

I don't know what's going on. I just want you to do whatever is best for me at that moment. 3561s

Always remembering that this is not my home. 3566s

So there are two sentences there. Do what is best and remember where my home really is. 3571s

No, she trusted me more or less to take care of her when she was a child. 3579s

I trust her now to take care of me when I will not be a child. Well, 3585s

yeah. Somebody said, where did you go up? And I'm like, 3593s

that was never on the die. That was never on the to-do list. Was it? I missed that to do list to 3599s

grow up. I don't ever want to do that. I mean, I'm getting older, but I don't want to ever grow up. 3604s

So I trust her now to do whatever is right. Her and the doctors and get the best advice again 3610s

and get everybody involved and say, okay, that seems like a good plan. Let's go forward. 3615s

Or, you know, it's enough. God does. God always makes the ultimate decision. 3623s

All right. 3632s

Always does he do. So you can have this great plan and say, I'm not going to do this at our other 3633s

and you could still live 20 years past that. You know, the story of Isaac? Yes, two boys. Remember, 3638s

Jacob and Esau. He has his boys come form and he's going to bless him because he's about to die. 3646s

He thinks he was another 25 years. That's how well he knew what was going on. He just lived an 3650s

25 years past that and that was the whole day they had to fight over Esau as Harry Coden. 3657s

No, you remember that story? If you look at that closely, he's still around a lot longer. 3662s

We don't know what's going to go forward. You can say, do not resuscitate and God can come in 3668s

and say, our resuscitate, we're going to keep going here. When things are taken away, 3674s

are you actually killing somebody? No, they're dying. 3681s

And maybe we're just topping that process or slowing it down. 3688s

But maybe we should just be okay. Because what's the worst thing? Is death the worst thing? 3694s

No. The worst thing is not being connected to Jesus and not wondering what's going to happen after that. 3702s

That's far worse than death. Because who said earlier, I am convinced that neither, 3711s

you know this verse? Life, nor death, or angels, nor demons, or the present, or the future, 3717s

or anything else. It's all of correct creation. We'll ever be able to separate us from 3724s

love of Christ, love of God that is in Christ Jesus our Lord. 3729s

The other thing is, no matter what you do, remember you're forgiven. 3736s

So when you have a conversation with your daughter, your son, your wife, go ahead and make the 3741s

decisions, knowing that God is with you and it cares for you. Do what's best for me, but know 3745s

you're forgiven. If you end up making a mistake, you know, I raised you. I made a few mistakes with 3750s

you. You're not a mistake for the record, but I made a few mistakes along the way. If you make a 3756s

mistake and you think that later, just remember you're totally forgiven. All right, now how do you do 3763s

this? Way back when in journalism, right? You all take journalism? More or less. I went and 3768s

helped with the school paper, but I was the guy that put together the puzzles. That was my job, 3777s

you know. And then the old days, if you heard of this thing, you just called a typewriter. Have you 3781s

seen this thing? And so you had to type out the puzzles and leave the spaces and that was my job. 3787s

But the other people who are doing actual real stories, who, what, when, where, why, and how, right? 3794s

So who do you have to talk to? Whoever your agent will be. What do you got to talk about? 3801s

What kinds of treatments? Maybe this whole best interest standard. Just do what's in my best interest. 3812s

When should you do this? Tomorrow. All right, you can't do it yesterday. That's already gone. 3820s

Right? Oh, good. Preacher, it's in the guild. Not the first one. 3829s

It won't be the last one. But you were never Catholic. I have relatives. So, I mean, community 3837s

family, we're in this together. When should you do it? I mean, the suggestion often is the day after 3849s

Thanksgiving. Seriously now. The day after Thanksgiving, the whole family is together. Let's just sit 3854s

down and talk about this. For, you know, some other time, but to really sit down and talk about it. 3861s

And say, you know, I raised you, if it's your kids. And I've taught you all my life that what's 3868s

most important is Jesus loves me this I know, or the Bible tells me so. I want you to think about 3874s

that as my life continues to go forward. I may have Alzheimer's. I may not be able to tell you this 3881s

myself, but I want you to remember that. And when it comes, and if you're okay making decisions 3887s

on me, just think about that. Do the best you can. Think about what's in my best interest, 3894s

but make sure you'll always remember your child of God. 3901s

Does that make sense? Yeah. 3912s

It's been my experience that if when I would go home a thousand miles away from here to visit my 3924s

mother, a widow, I would always talk to the pastor and I would always talk to the ladies that 3930s

rode with her to church. And one of them told me one time your mother shouldn't be driving. 3938s

I don't know that because every time we go home and go somewhere, I'd drive. 3944s

And so I didn't realize what that's going on, but you find that out if you stay in touch with 3952s

community. Going back to this example would it have been appropriate for somebody in the community 3957s

or in the church to call one of the four brothers and say, your mother's going in for surgery, 3964s

she's going to be under an anesthetic. Maybe you should consider being here. I don't know if 3970s

that's appropriate for the church or not. Oh, I think it is. Because what is the church? 3977s

It's a family, right? So I teach pastbroker and one of the books in pastbroker is the whole question 3984s

of confidentiality. We are not in the church under hippo-loss, never have them. 3993s

Now, if you tell me something in confidence, confess to sin, I absolutely cannot tell anybody at all. 4001s

Right? If they want to put me in prison, I go to prison. I don't care because I can't deal with it. 4009s

But you tell me, you know, pastor, please pray for my dad who has the same name as I do, which 4014s

confuses me. But okay. So please pray for my dad. And it's okay. You can talk about 4021s

public and Sunday morning. We're going to pray for him. Now as a group, we're praying for Richard's 4026s

debt. Is he a member here too? No. But we're still praying for this guy and we're thinking about him. 4033s

You might say, you know, I know Richard's debt. Maybe I should go and visit him. But now you can 4039s

clock the Rick and get it figured out. The rules of a family are different than the rules of a 4044s

healthcare system. What is the rule of the family in terms of confidentiality? 4050s

It stays in the family. We don't err our dirty laundry out on the public streets. 4056s

But on the other hand, we're here to take care of each other. 4062s

Correct? So it would have been great if we'd have really understood from her how serious this was. 4068s

I mean, I had, it didn't add up. You know what I mean? There was something in my gut says, 4077s

this isn't quite right. But I didn't do anything about it. And I was probably the one who could have 4083s

done something about it. I didn't know her other three sons. I never met them. So I knew people who 4090s

knew them. And when I look backwards, I wish I had done it. But absolutely. Because in 4096s

any ways, you might know somebody better than their own family does, as you're saying. And especially 4107s

as we get more and more spread out from each other, right? That our kids aren't necessarily with it. 4113s

I see my daughter every day. She works in the same building. I see my grandkids every day. 4120s

Well, I've been here this week, but every day I see them. Most people are not like that. I see my son 4127s

every night because he lives down the hall. And I hear weird noises in the distal again. 4133s

When should you do this? Whenever it works. Maybe there's a day where we're just to invite people in 4144s

and we have some crazy preacher from someplace come up and talk about it. And then we go from here 4152s

and we go off off and talk about it with our families. Well, you could do that. 4156s

Right? My brother in Texas, I'm in Texas in Waco did this thing called death panels. 4164s

They were heard of this thing. Well, in a Saturday morning, they had conversations over this 4169s

specific issue. It'll program a center of body away in different parts of the church and they talk about it. 4174s

Where should you keep these documents? 4184s

Some people now are putting a DNR. They put a tattoo at some of them, but someone just wear a wristband. 4190s

Now, you were talking about it had a be on a wall. Some of them people are now, and this is 4196s

modern technology stuff. Some people take a picture of their documents and carry them on the phone. 4206s

And then the spouse knows where they're at. Or if you take a picture of it, you can send it to 4213s

your child or whoever and they would have it just as easily as you would. 4218s

Almost every healthcare system now has a way to enter into the healthcare system. 4224s

Right? So if you're clinic and your doctor and your hospital or part of Baylor, White and Scott. 4229s

Was that not right? Scott White. Okay. 4238s

That's all there. Then it's all there. But of course, some of us travel regularly. So that's 4243s

still out there. When it comes to me and my case or people, we don't necessarily have to have this 4247s

anywhere. If I am injured, my wife will, and they say that's my wife, though, that's talked to her 4254s

right off the bat. If my daughter comes, she might have to prove that this is an okay thing, 4259s

but on the other hand, they'll probably talk to her right away. 4266s

If it's somebody else, what would happen if you appointed somebody that was not a family member? 4271s

My lawyer, my personal lawyer, always believed that was the best idea. Because then you could have 4279s

somebody to blame. And the four boys wouldn't be blaming each other. There would be somebody else. 4286s

And it'd be that guy's job to bring everybody together and make sure we're all on the same page 4292s

and do it well and then go forward. So you could appoint somebody else. So, you know, at this point, 4297s

carry can't appoint her kids, but you may not want to appoint your folks who are still up in 4304s

Omaha, right? Your dad's in the Cayman Islands. Okay, we only go down that road at all. But okay, 4309s

so they aren't even nearby here. So maybe she's appointing Steve, who's in the, 4320s

you're marty. He's appointing Steve, who's in the next office over. There you go. 4327s

Who's an amazing guy and then okay, but you could do this with somebody else. 4333s

And maybe there's somebody appointed as the main person who's a son or daughter and they're 4339s

and there's somebody from the church who's the secondary who could go in and immediately 4344s

induce some conversation if your kids aren't living here. That's another way of doing this. 4348s

Absolutely. You want to make sure each agent has a copy of the documents. At least has the 4360s

copy that says on the guy. You know, I have the right to be here. I get away with all kinds of 4365s

things, but it's, you know, I'm able to just kind of go in and that doctor wasn't sure he 4374s

wanted to talk to me, but he had nobody else to talk to. And so he just wanted to find out about 4381s

her. And so at that point, we're having a conversation. Why should you do this? We have this thing 4386s

that's up here. We already talked about, well, how do you do it? You blame me. So there was some 4395s

crazy preacher that came from up north and he said you should do this and we're doing it because 4400s

of this crazy preacher. And I actually wrote this for another group and it's the same thing. 4405s

You blame me. I don't care. It's like when you tell your daughter that some guy has been in trouble. 4410s

You say, my folks won't let me do this. Just entirely blame me. Now, second thing I gave you, 4417s

or actually, Terry gave you, is a sheet of paper that comes from the Lutheran Church in the 4426s

very center, which is principles about the end of life. I don't think we're going to go through all 4430s

these, but you can read them. It basically says, God's in charge. That's like one and two. 4435s

Three, it says in good conscience, you may let nature take its course. 4441s

Four, you can have pain-killing medication. I hate that phrase. Pain medications that might stop 4449s

the pain, that might even shorten your life, but the goal is always to deal with the pain. 4455s

Five, six, six, six, we're all important. 4464s

Seven, suffering is not the worst evil. Sometimes God uses suffering to build up other people. 4470s

And sometimes He uses it to build us up. When were you closest to God? 4478s

When the sun came out tomorrow, in our weakness, when things were tough. When you're up all night 4485s

because your kids sick. Seven, eight, eight says death is a spiritual thing. And how death works 4493s

is a tough thing to figure out. Nine, it says it again. It's a spiritual that tends to 4509s

important one. It says you're forgiven. Eleven and twelve say these are a big issue for our day and 4514s

but this is for you. If you want this whole report, it's on the web called Christian Care at 4522s

Life's End. You're going to read the whole thing if you wanted it. You go to, I put it on there. 4529s

Yeah, CTCR is the Commission on Theology and Tricks Relations. 4535s

A Lutheran Church in Missouri Senate. So you just go to LCMS.org and this whole thing is here. 4539s

And it's what? 40 pages or something like that. 4545s

So what are you going to do? My hope is that you'll have a conversation 4553s

in the near future, whatever that means. But don't put it off till spring. 4561s

Well, I don't know. When is spring around here? Friday? Tomorrow? Okay. 4567s

South Dakota, we don't normally get spring. We just doesn't happen. We go directly from winter 4579s

into summer. And then maybe a day last year was snowing all the way through April. 4584s

And then all of a sudden the middle of May it got hot. But you know, we lost church once on 4590s

the April last year. But yes. So we don't really have spring. But you know, if you don't wait until 4596s

April, whatever, tax day, April 15th. Fixing time, think about it, talk to your kids. 4609s

You're talked to wherever you're appointed. And I just want to have a conversation. 4615s

I'm doing this only because this crazy nut from up north came down and he thought it was a good idea. 4621s

So I'm just going to try it. Just to see what you think. 4626s

Please. 4632s

Night Sí? 4648s

Did not get much money from your father so you want to do how to do your own act. 4652s

They welcome up to the money and the time is spent. 4660s

But there is no difference between the younger and older. 4666s

And as you know, not from all of us, you have kids. 4671s

It is not too early to put something down to where or what you want done. 4680s

Is your life before and after? 4687s

Sure. I actually am fully agreeing with you. 4691s

You might have, you might only, my difference might be there might be a little more detail if you're older. 4695s

But I actually, I am a big fan of, normally I talk to people who are my age because we'll bring them in because they want to think about their parents. 4706s

And then hopefully they will talk to their children. 4718s

And so they will get, I mean, how do you get to people? 4722s

So if I can get people who are in their 40s and 50s to think about it. 4724s

And the reason they're coming is because they have to deal with their parents. 4728s

But at that point, my hope is that we'll talk about their children and everybody over the age of 18 should do this. 4731s

Because if people under 18 are still under their parents care, that's not an issue yet. 4739s

But anybody over the age of 18 should be done. 4743s

If you go into the military, they're going to ask you to do it. 4747s

But I went into the service just having to be a different one. 4754s

Right? Do we still sing that hymn? There are some places that abandoned. 4758s

Onward Christians, soldiers. 4762s

Do we still sing that one? Yeah, we still got it, right? 4765s

I just did a different service. Our pension plants better. 4769s

But our healthcare might not be. 4775s

Tracker is a pretty good deal. 4779s

Tracker? Are you on a Medicare now? 4783s

And Medicare. 4788s

And you just get, you got to end all this deal now, right? 4791s

Congratulations. 4794s

Oh, there you go. 4798s

So we want to make sure your pension goes as long as possible. 4809s

Keep him going for it. 4812s

Let's keep up an info. 4814s

Preservatives. 4817s