1. Advance Care Planning: Part I Living Faithfully, Dying Gracefully™ Series Faith and Health Ministry Gloria Dei Lutheran Church

2. Our Goals To help you: Reflect: What is important to you? What are your hopes, wishes, and concerns? Plan:What choices do you have? What information or help do you need? What steps can you take to make sure your wishes are honored? Do: Complete the necessary forms and communicate your wishes 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 2

3. Housekeeping Two-part series; 90 minutes; this morning and Saturday, January 17, 9:00 – 10:30 AM Ask questions any time – but, we may “park” some questions until Part II We will take a short break at around 9:45, but feel free to move around, get snacks, or use the bathrooms at any time Share only as much as you are comfortable sharing Respect the confidentiality of what others share Every faith perspective is welcome Nothing said or provided during this workshop is intended as legal advice or medical advice. Please consult your lawyer or doctor if you have questions relating to your specific situation 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 3

4. Part I: Overview Reflection and prayer Defining terms Sharing experiences making health care decisions for others – what have we learned? How to select and appoint a health care agent Communicating your wishes Questions? 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 4

5. Part II: Overview How do you envision your own end-of-life journey? How do you define a “good” death More about specific health care choices – specific diseases and specific medical interventions Ethical concerns: What guidance does the ELCA provide? How may loved ones and spiritual guides best support you? Completing a long-form health care directive Communicating your wishes 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 5

6. Our Fear of Aging and Death As a society, we are uncomfortable with aging, dying and death Many of us have never witnessed a death and don’t know what to expect We distance ourselves from aging and death – we don’t talk about it, we don’t want to think about it, and we avoid what reminds us of it We have outsourced aging and death to nursing homes, hospitals, hospices and funeral homes Doctors are trained to think of death as a failure to be avoided at cost. When someone dies, they say, “We did everything we could.” 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 6

7. Christian Perspective Aging, dying and death are not the enemy; they are a natural and important part of life End-of-life can be a time for healing, reconciliation, gratitude, forgiveness, spiritual maturation, and joy. Death is not the end – it is a transition – a transition into new and eternal life in Christ. God is always with us, even when we cannot feel God’s presence 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 7

8. God Is With Us in Every Stage of Life “Even to your old age and gray hairs I am he, I am he who will sustain you. I have made you and I will carry you; I will sustain you and I will rescue you.” Isaiah 46.4 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 8

9. Nothing Can Separate Us From the Love of God “For I am convinced that neither death, nor life, nor angels, nor rulers, nor things present, nor things to come, nor powers, nor height, nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord.” Romans 8.38-39 1/4/15 © 2015 Catharine Simler. All rights reserved. 9

10. Opening Prayer Eternal God, We give you thanks for your Son Jesus Christ, Your Word, who became flesh so that we might live abundantly, in this world and eternally, in Christ. We take comfort in your promise given to us through the Prophet Isaiah: “Even to your old age and gray hairs I am God, I am he who will sustain you. I have made you and I will carry you....” As we gather today to reflect on our own mortality and our hopes and wishes for our final journey, help us to remember that you will always be with us and that nothing can separate us from your love, through Jesus Christ, our Lord. Amen 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 10

11. Advance Care Planning Is an ongoing process that includes – Thinking about our hopes and wishes for the final stages of our life, including how we might want to die – what are our deepest needs and concerns? – Conversations with our loved ones, our doctors, our faith leaders, our caretakers – Choosing a health care agent and conversations with our health care agent – Completing or updating a health care directive 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 11

12. Health Care Directive A legal document Goes into your medical files Names your health care agent – someone to speak for you if you are unable to speak for yourself May describe your hopes, values, wishes and concerns Short and long forms are available 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 12

13. Life Experiences Making Healthcare Decisions for Others -- Discuss in Pairs, Then as a Group -- Have you ever had to make healthcare or end- of-life decisions for a loved one? If not, have you watched someone else shoulder that responsibility? Was there a health care directive? What helped you most? What made your job harder or more stressful? 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 13

14. Learnings It is very likely that there will be a time in your life when you cannot make health care decisions for yourself These decisions can be complicated, emotional and are often made under pressure in a time of crisis Planning ahead can help ensure that you receive the kind of care you want 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 14

15. Learnings Planning ahead will help you and your loved ones make the most of this final journey – this is a holy and precious time in your life Your family will experience less stress, anxiety, pain, conflict and guilt if you have appointed a health care agent and made your wishes and preferences known. Advance care planning is a gift you can give the people you love. 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 15

16. Your Health Care Agent Choosing your health care agent (see handout) Explaining the responsibilities of a health care agent to someone you are considering (see handout) Discussing your values and wishes with your health care agent (see handout) Documenting your choice in a health care directive (walk through short form) 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 16

17. Having the Conversation Everyone is different No one can read your mind Even your spouse or children may not really understand your hopes, wishes and concerns (although often they think they do) Once you have thought about your hopes, wishes and concerns, you must communicate them to your – Loved ones – Health care team – Caretakers 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 17

18. Too Many People Avoid These Conversations 60% of people say that making sure their family is not burdened by tough decisions at end-of-life is “extremely important,” – BUT 56% have not communicated their wishes to their loved ones. 82% say it’s important to put their wishes in writing, – BUT only 23% have actually done it. 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 18

19. Doctors Also Avoid These Conversations 80% of people say that if they were seriously ill, they would want to talk to their doctor about end-of-life care – BUT only 7% have had an end-of-life conversation with their doctors 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 19

20. Barriers to Conversation About End-of-Life Issues Family dynamics Fear and denial Too painful Cultural issues Interfaith issues Busy schedules 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 20

21. More Barriers Distance Superstition Procrastination Too complicated 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 21

22. Strategies for Overcoming Barriers Excellent resources available on – honoringchoices.org – http://theconversationproject.org Conversation Starter Kit (walk through Conversation Starter Kit) 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 22

23. Homework (see handout) Review the handouts. Think about whom you would like to ask to be your health care agent. If possible, have a conversation with that person about the responsibilities of a health care agent and your personal hopes, concerns and wishes. If you are able, complete Part 1 (or Parts 1 and 2) of the short form and bring it with you on the 17 th. If you like, you can sign it on the 17 th and we will witness for each other. Take a look at the long-form health care directive and think about the questions on page 6 (the optional questions). Don’t worry about the multiple-choice questions. We will work through them together on the 17 th. Use the Conversation Kit to have a conversation with a loved one about your hopes, wishes and concerns around end-of-life. If you encounter barriers, perhaps you could share them with us on the 17 th. You won’t be the only one. If you have been diagnosed with a terminal disease and have not already done so, schedule a conversation with your doctor or medical team to discuss how the disease is likely to progress and what decisions you (or your health care agent) may have to make as it progresses. 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 23

24. Questions? Thoughts? 1/4/15 (c) 2015 Catharine Simler. All rights reserved. 24