How Does Missouri Law Address the Inclusion of Religious Directives in Living Wills?

What is a Living Will?

A living will is a statement that specifies whether or not a person wants to receive interventions when they become incapacitated. When this occurs, the person can’t express their wishes for which treatments they want to avoid. Creating this document can help resolve disputes or answer concerns during an already difficult time for the family.

Living wills in Missouri are typically witnessed but are not always notarized. However, taking the extra step to ensure it will be enforceable when necessary is not a bad idea.

Durable Power of Attorney

Similar to a living will, a power of attorney aids in decisions upon being incapacitated in that it appoints a surrogate of our choosing to handle questions and concerns on our behalf regarding our end-of-life (or during incapacitation) care.

The appointed person should ask questions about anything they don’t understand so they are fully prepared to handle the stressful decisions if the time comes.

How Are Advanced Care Directives Created?

Creating these necessary documents can be challenging because you don’t know what life-saving measures may be in order until something happens. The best strategy is to work with medical professionals to determine some of the most common severe issues and the options available to treat them to learn what you feel is necessary or what aligns with your religious beliefs.

Below is a list of some of the common situations that may require extraordinary care;

• Dementia or Alzheimer’s – these health issues render most patients unable to make decisions of sound mind any longer unless they are lucid, which may be rare.
• Brain damage – hemorrhaging, traumatic brain injury, and more
• One or more organs fail.
• Intense pain that can’t be avoided or treated to a comfortable level
• Unable to eat, drink, or provide basic care for themselves – in some cases, those who experience a traumatic event or serious injury can no longer provide basic care needs for themselves.
• Terminal or incurable disease – if medical staff has deemed that the disease is terminal and there are limited to no treatment options available.

Extraordinary Measures

Once you’ve determined some of the most common issues that can create incapacity, it’s best to begin going through the list of extraordinary measures to decide what options align with your wishes so you can clearly communicate that to your durable power of attorney.

Kidney dialysis – if a kidney is failing, this may be the only option, but it may require a lifelong commitment

Organ transplant

CPR – commonly discussed with the Do Not Resuscitate option for end-of-life care, some prefer not to use these extreme measures.

Feeding tube or artificial hydration – if a patient can no longer eat, a feeding tube for nutrients or supplements may be used. Some prefer not to use this measure due to possible obstruction or other issues.

Ventilator or respirator intervention – discuss with your durable power of attorney whether or not you would like to have extraordinary measures if you are no longer able to breathe on your own.

Significant surgery – along with severe injuries or a serious cancer diagnosis, significant surgery may be required. These significant surgeries can pose real risks, and you should discuss what level of surgery you are comfortable with rather than foregoing it.

Shock therapy – is sometimes used if the patient is experiencing an extreme shutdown of function.

Palliative care – can consist of family visitation, therapy choices, sedation, pain medication, and more.

How Are Religious Beliefs Accounted For With Directives?

Each religion has different beliefs about what extraordinary measures should be taken.

As an example, the Missouri Catholic Conference states in an article that according to the Catholic church, some extraordinary measures are morally optional treatments and that they prolong the natural dying process.

Further stating that “Our Church suggests that when making a decision to accept or refuse a treatment, we should take into consideration the type of treatment recommended, how risky or complicated it is, its cost, side effects, how painful it will be, its availability…”

Each religion will have its own views on how the sacred nature of extraordinary measures should be viewed, so it’s imperative that you speak with your durable power of attorney to ensure that they understand they genuinely value whatever your beliefs are.

Other Preferences to Discuss

Essential items, such as where the patient would prefer to pass away, should be discussed. Some prefer to die peacefully in their home, while others would like to remain under the watchful eye of medical staff.

Hospice care as needed and at what level. This item may differ for all religious beliefs and should be discussed in detail.

Whether or not the patient would like to donate organs – this can have religious implications as well and should be discussed at length with each person to determine what their beliefs/needs are.

Sacred Values: Respectful Conversations

The bottom line is that you will want to ensure that all possible realistic scenarios are discussed with someone you trust and who respects your values and beliefs. The end of life is such a sacred time for all of us, and we should respect wishes or deep-rooted beliefs and honor them during the end of life.

If you would like assistance creating advance directives for your loved ones or you so your loved ones have less to worry about when the time comes, contact our office at (314) 347-3567. Though sometimes hard to conceptualize, creating a solid plan and expressing our values can be an incredibly caring thing to do for those who love us the most.