3-6-2016 Bioethics Part 47

The speaker begins by praying for guidance in discussing the topic of death and dying. They mention that they have been exploring this subject through the lens of virtues such as courage, hope, love, faith, contentment, and constancy. They explain that constancy is important in the face of death because it means not shifting away from one's beliefs and not abandoning those who are dying. They discuss the challenges of dying and why it is necessary to practice these virtues today. They mention that advancements in medical technology have raised new questions about end-of-life decisions, such as the use of DNRs and the decision to pull the plug on life support. The speaker acknowledges that discussing practical aspects of preparing for death can be uncomfortable but necessary. They mention the importance of considering healthcare and end-of-life decisions, as there may come a time when one is unable to make decisions for themselves. They discuss the availability of advanced healthcare di All right, well, let's pray and get started this morning. God, thank you for the gift of today, and we pray that as we think about some harder issues in life pertaining to death, that you would help us to think well and to live well in Jesus' name, amen. Okay, so, for the past six weeks, we have been looking at the subject of death and dying through the lens of the virtues. What are the six virtues? Let's go. Courage. What else? Hope. Love. Faith. Two other C words. Contentment. Constancy. There we go. What the heck is constancy? That's the one we covered last week, or two weeks, was it last week? Yes, it was last week. Hmm. Yeah, stick-a-with-it-ness. That's right. Why would something like constancy be so important in the face of death? Not shifting away from what you believe when it's actually tested. Yes. Truth. Not changing your mind when it's about to be over. Yeah? Just starting to live in dramatically different ways. Though that is a temptation, this is why a virtue that needs to be practiced today. Good. What about constancy being shown towards other people that are dying? You being the one that's not dying. What does that look like? Not deserting them. There you go. Yes. Staying with people who are dying, even if you might not like to, especially in a culture that doesn't really like death very much. As long as we're talking about our own death, if it's people that we have defined as not worth living, then that's fine if they die. But we don't like to be around people who we know are dying. So we must practice the habit of constancy today. Before I move on to what we're going to talk about today, I'd just like to think about that one thing. We kept coming back to it over and over again. Why is it that you and I have to begin to live and practice these virtues today? There's not only just one answer to that, there's a couple of answers. Because dying is hard. There you go. What else? We need to be prepared when hard things actually come along. Yes. Living is hard. Yes. But you're not going to become courageous by accident. Fear is a natural state of being. Love is not. Certain kinds of love towards certain kinds of people is. But a true love for others is not. Dying well is hard. And dying well is only getting harder. It will never be easier to die than it is today. With every day we have more and more procedures, more and more quote-unquote advances. These medical advances in the realm of medical technology requires to ask questions that no one's ever had to ask before. Can you give me an example of something that would fall under this kind of category? Something that nobody has ever had to ask before, but we have to ask today. You can think back like 50 years. What have we been starting to have to think about in the last 50 years that nobody in the history of the world ever had to think about? DNRs? Okay. Yeah. You could have hypothetically had a DNR right at some point. Like don't, just don't thump me on the chest when I'm gone, when it looks like I'm going to be gone. But they're definitely more prevalent now because there's more ways of keeping you alive. Any ideas? Let me give you, I'm going to give you the modern day common colloquial term and you tell me why it's new and nobody ever had to face it before. The term, should I pull the plug? Why would that not be a term or a concept that anybody would have had to deal with 150 years ago? Okay, so technology of life support wasn't what it was today. Anything else? Even more basic than that? There was no plugs. Exactly. Just the mere ability to have electricity and have electricity readily available made it so that you could have a toaster, made it so that you could have incandescent lights, and also made it so that you could begin to work on ways to keep people artificially alive. We're not going to be talking this morning about keeping people alive through medical technologies, but it's the simple fact that if you can pull the plug, then you have a wide range of possible options. I know that some of you here are very much bent towards practical things as opposed to theoretical things. The virtues seem nice and important and all, but they don't really give us anything concrete to do. It's just kind of like this general, directed way of living. It's like, okay, but just give me something that I'm supposed to actually carry out. This is a common critique of virtue ethics. So this morning, we're going to talk about some of the practical bits of preparing for death. It's not going to be very pleasant, maybe, but it is necessary. This morning, we're going to be looking at the topic of health care and dying, preparing now for that eventuality. Before I begin, I've said this at multiple points along the way, but I need to make it specifically clear when it comes to something like this. This is not a sermon. What I'm about to teach is something that I want you to take very seriously, but I do not want this to come off as, thus saith the Lord. Even the place that I stand, I want it to be a theological statement. Now, we just so happen to have this set up here, it's not like I would have to do something like this, but it is beneficial to stand here instead of standing up there, because by standing down here, and also it's not just my mere physical presence, but it's one of those things where it's like, this is something that I want you to consider strongly, but this is not preaching. In fact, if this was a sermon, or was delivered as a sermon, then the person that was delivering it should be at least disciplined, if not removed from the teaching position of the Church altogether. I hope that becomes clear why as we go forward. This is, however, a studied, thoughtful, I hope, careful opinion of a leader in the Christian community that has the time, desire, and possibly the giftedness to help others think well about some important things. So, with that great warning being given, I plunge ahead with great caution, I hope. It used to be so easy to die, right? You just used to get sick, and you were a goner. That was just kind of the way it was. And as much as some of us maybe would like to live in that kind of time and place, it would be substantially easier in many ways. I very much doubt any of you would want to go back to the 1600s. It only sounds really good if you can kind of go back there in a time machine, hang out for lunch, and then get back here real quick. And if you do think that living in the 1600s would be a great idea, that really says more about your understanding of the 1600s than the 1600s themselves. It was a very non-pleasant time. You go, well, what about the 1400s? Also equally pretty miserable. You can kind of find any time. There's never been a better time or a better place to live in very many ways than right here and right now. However, the simple fact is that we do not live in the 1600s. And therefore, as much as you might not want to think about the things that we have been thinking about, the things that we will be thinking about, God has, as Paul puts it in Acts 17, determined the time and place that we will live. You might hate the 21st century in America, but you better buckle up because that's where you currently reside. And to loathe the place and time in which you live says something about the way that you view the God that you worship. So, there's probably going to be, in this time and place, statistically at least, there's probably going to come a time in your life where you will need the help of the medical arts, but you will be unable to make decisions for yourself. That statistic is only rising. So, there is a greater and greater likelihood, going forward, that there will come a time, maybe an extended period of time, where medical decisions on your behalf will have to be taken by somebody other than you. Can you think of a circumstance in which this would take place today? It could be anything. As detailed or as general as you'd like to make it. Coma. That's right. You're in a coma. You're in the middle of a surgery. Jake? Heart attack. Alzheimer's. There's a big one. All kinds. That took us like 10 seconds. We could literally come up with hundreds of instances in which you, either in a very emergency type moment, or an extended care period of time, will have to have somebody else make decisions on your behalf. The question is, what should you and I do in light of this reality? How can we know that we will be treated in the ways that we would like to be treated when unable to weigh in on the matter? Now, thankfully, we're going to talk in the sermon a little bit today, and it's not really the main point of the sermon, but it's something that stuck out to me. Moses' father-in-law is going to give some very wise advice to Moses at the end of Exodus chapter 18. And it reminded me of the blessing of wisdom that comes from other human beings that haven't been Christians for a really long time, or aren't Christians at all. I think we tend to listen to or appreciate the benefits of Christians in the world more than non-Christians sometimes. However, when it comes to something like what we're about to look at, you and I ought to thank God profoundly for the work that's been done by Christians, non-Christians, Buddhists, monks, Sikhs, Jews, everybody, in thinking about, in the medical field, what should we do in light of all of this medical advancement that we have that makes it so people are more and more likely, through time, to not be able to make decisions. Two kinds of legal forms are now widely available. These are advanced health care directives. You might have heard of this as called a living will. And the other one as a power of attorney for health care. And while I rarely do stuff like this, I thought it would be helpful, if nothing else, to very quickly look at these documents so you can just kind of see what the heck they look like. And I can very quickly explain the differences between them. So, we're going to try and do this. Hopefully. We'll see. Man, I'm amazing. You can't see it very well. You can't see it super well. However, I'm going to just try and explain this a little bit. This is the power of attorney for health care. This is a very simple document. This is a document that is not able to be used in every state. It is able to be used in the state of Tennessee or it wouldn't be worth doing this. However, most states allow you to do something like this. The power of attorney for health care is a more generalized document. So, you would just kind of put your name in. And then the part one is who will be your health care agent. Your health care agent is the one that would make your decisions for you. Now, the interesting thing about this, and it's kind of a bummer that you can't read this on the side. Ooh. Bingo. Look at this. God bless technology. Notice that there was a lot of concern in the Christian community because Christians tend to be psychos sometimes, that what this would do would give the government the ability to kill you. I just want you to notice this is actually, this document was produced by the American Bar Association. So, notice who they say not to choose. This is going to be the person. Your agent is going to be the person who makes these decisions. So, it shouldn't be a health care provider or an owner-operator of any health care facility, like a hospital, nursing home. It's not a spouse employee or spouse of an employee of your health care provider. A professional who makes these kinds, who evaluates your capacity, somebody who works for a government agency that's financially responsible for your health care, there you go, has already been appointed by a court to be your guardian or already serves as a health care agent for 10 or more people. It goes out of its way to say, if it's one of these kinds of people, don't do it. Now, could you tell me why? I mean, there's maybe different reasons for different kinds of people. We're not going to spend a lot of time on this, but could you think of why one of these would be a bad idea? Ulterior motives, exactly. Like, give me an example of one of those that would have an ulterior motive. Alright, so profit from extending your care. That's right, as an owner of this hospital, I'm going to make money should you remain alive or in a permanent vegetative state or something like that. Okay, good. Anything else? A spouse wanting to live with you? Now, it doesn't say spouse up there, right? It says a spouse employee or spouse of an employee of your health care provider. You and Tim got problems. Now, but this is actually going to get to an important point. You need to be very conscientious of who you choose because you could choose somebody who's like, I'm going to off this person so that I get the money, right? I'm going to have to talk with you guys later. Anything else? If we talk about extending life, what would be the opposite of that? Yeah, okay. Yeah, so you have a psychologist whose job it is to determine whether somebody's unstable or stable or whatever and then one of the patients is put under their care is then signed up to be this person's agent so they can just kind of be like, they're unstable. I have a reason to do this. Boom, done. Or you work for a government agency that's financially responsible for your care and the government goes, we're going to save some money. You're gone. Remember that most of the health care money in the United States that human beings spend takes place in the last six months of their lives. Most of the money. So I don't know how much money you, has been spent on you in the course of your lifetime. Might be a lot, might be very little. However, statistically, most of the money will be spent just in the last six months because people hate dying. So, if you had government agencies in charge of something like this, that would be a terrible idea because they could just off you. Oh, now I screwed it up. There we go. You can get backup agents, right? Why would you need a backup agent? That's right. Let's say that Marge is my agent. Marge and I are driving a car. We both get in a car wreck. Guess what? Marge doesn't have an agent. Maybe because I'm her agent. And then I don't have an agent because Marge is my agent. So, that's a bad idea. But we can have backup agents. But notice this is very much something that you don't have to have at all. Man, this scroll function is awesome. Okay. Then you have to actually say what are the powers that your agent is going to have? This part is interesting because notice what it says over on the left hand side. Part three gives your agent broad authority to make all healthcare decisions for you. Some states may limit your agent's authority. This form gives your agent authority that is as broad as possible even over life and death decisions. Some states require physicians to certify certain diagnoses before your agent can make some decisions. Essentially what that means is like you can't just walk in and be like guess what? We're done here. Marge and I were joking about this yesterday like if Marge had a hangnail and I was like it's okay, doctor. Just pull the plug. Right? We're just going to end it now. It gets to kind of this thing where in some states and a lot of states you can't just you can't if it was like we're going to take them off life support if the doctor was like well actually like the life support is actually sustaining their life there's a really good chance they're going to wake up you can't just be like I don't care. We're pulling the plug which is kind of beneficial. Right? But you have to actually sign off that you want these kinds of things these people to have this and you can cross out any of this. This is the nice thing. These forms are super moldable. So in this case over there under point one to agree to refuse or withdraw consent so they can either start stop or stop after it's been going on. Any type of medical care treatment surgical procedures test medications and all these kinds of things. Right? Using mechanical or other procedures that affect any body functions such as artificial respiration artificial supply nutrition and hydration that is tube feeding cardiopulmonary resuscitation CPR or other forms of medical support. Even if deciding to stop or withholding treatment could or would result in my death. Now you can say I like all that except the CPR stuff you can just cross it out. You can form these documents as much as you want but these people have broad power to make your decisions. They can get your health records they can get you out of the hospital even if it's against medical advice. Again you need to cross any of this off. They can decide what to do with your organs all that kind of good stuff. Yes and we're going to get to that because it's very important. Yes They do have to be special. You can even add special instructions or limitations for your agent for example you can say I would only like to receive artificial feeding through tubes for three months and at that point it's over. You could like write a 30 page book and some people do and we're going to talk about those people in a minute. So when will this power be effective? It's essentially effective as you sign it and then there's some general provisions then you just sign. Check that this is the crazy part at least for some of us at least it would seem kind of crazy where you sign here I understand what I did and then you have to have two witnesses this is in the state of Tennessee at least you have to have two witnesses that are not the person signing the document or the agent. You have to have four people involved to make this a legally binding document or if you don't have any friends then the next part is this part here at the bottom where you go see a notary. So that would be medical power of attorney super broad you can limit it as much as you want you can add as much as you want but essentially it just provides for somebody to take care of you in the case of you going away. The other one is an advanced directive. These are very much detailed towards the state some states don't allow these very much at all this is the Tennessee one as you can see so you put your name your address and who your alternate is going to be so then you have instructions for liability of your agent here's where it gets interesting so this one is way more not way more quite a bit more detailed so you say here's who I am and I want these kinds of things I do not consider the following conditions to be an acceptable quality of life so permanent unconscious condition it's like a permanent vegetative state you're in a coma you ain't coming out permanent confusion I become unable to remember, understand or make decisions I do not recognize loved ones or cannot have a clear conversation with them what's another term for that? Alzheimer's or dementia I would like to return to the first statement I do not consider the following conditions to be an acceptable quality of life dementia is not an acceptable quality of life this is a legally acceptable terminology in the state of Tennessee we do not have assisted suicide yet we most likely will however what this says that is not an acceptable quality of life for me I'm going to determine that so that should that time arise then essentially everybody ought to know that I don't want to live that way anymore that opens quite a door next we have an even broader category dependent on all activities for daily living I am no longer able to talk clearly to myself or clearly or move by myself I depend on others for feeding, bathing, dressing and walking rehabilitation or any other restorative treatment will not help so it's not a temporary thing it's a permanent thing I'm done at that point or an end stage illness this is different I have an illness that has reached its final stages in spite of full treatment so you can kind of tailor this to whatever you want then the important thing here is if my condition is irreversible it's part down at the bottom that is will not improve I direct that medically appropriate treatment be provided as indicated below if I mark no below I authorize withholding or withdrawing of such care so CPR electric shock chest compressions breathing assistance what this means is that this goes back to the first thing so if I have dementia and my heart stops and I have checked no I don't want CPR that means that if I have dementia and my heart stops they cannot resuscitate me or if it's I've got stage 4 brain cancer and I have a stopped heart they don't bring me back life support continuous use of a breathing machine IV fluids medications all that kind of stuff treatment of new conditions this is interesting we're going to talk about some of this stuff in the future use of this is an interesting one use of surgery blood transfusions or antibiotics that will deal with a new condition but not help the primary illness this happens almost all the time with people who are extremely sick in the hospital so you're in the hospital you have brain cancer and because of your time in the hospital you get an infection and your kidneys start to shut down this has nothing to do with your brain cancer whatsoever but just there's another problem in your body and what this is I don't want you to just keep fixing this other thing that will prolong me living even though this other thing this brain cancer is killing me or artificially provide nourishment and fluids that would be artificial feeding so this is much easier to tailor you go this is some heavy business right here it is just know this you have to remember this we'll talk about this in a second whether or not you have this marked on a piece of paper somebody is going to have to make these kinds of decisions that's a real good question and it's not very clear who makes those that's going to be something I get to here in a second as well you can add as much instruction as you want you can add a whole Russian novel on here if you wanted to you can also talk about organ donation or you can donate your whole body to science then again you sign with witnesses or you sign with a notary so with all that being said just because these documents exist as I am sure you can see it doesn't mean that these decisions become easy first you will have to choose who you will have to serve as your agent or I mean sorry you have to choose what document you would use you have to make that kind of decision they are not totally different one of them is just more kind of detailed than the other one the state of Tennessee one is not nearly as detailed as some other ones I personally don't have a strong preference for one or the other I will say this it doesn't matter if you do it on either one I would strongly encourage you to not try and micromanage your future possible health care options this is where the virtues come into play it's not simply the decisions we make but why we are making them not only is it simply impossible to deal with every eventuality that might come up in one's life those who want to really really really well define everything that is going to happen to them speaks a lot of times to what in that person's character and heart fear because they want to make sure that they are the one in control of everything that happens exactly yeah a large document like that might as well be Frank Sinatra singing I did it my way I will only go out on my own terms exactly how I want to Van Drunen one of the guys we've been reading throughout this brings up this good thing about why we wouldn't want to kind of do this consider an analogy from civil law he says legislators ordinarily make laws that state general rules and judges are expected to apply these laws to specific cases but some cases involve circumstances that make the application of the general rule seemingly just in itself unjust in a particular situation the fact that such cases exist does not mean that there should not be general rules but it does warn about overconfidence and anticipating future scenarios so you should be very careful to say okay I'm not in control of everything and just having detailed things isn't going to cover everything anyways and also isn't going to be just in every situation I could have detailed things on there that don't make any sense given the condition that I find myself in now you might think well Jeremy this seems so cold and sterile and unloving but I would argue that it is a wise thing that we can do for ourselves and a loving thing we can do for others as we all live towards death and this gets to some questions that were asked earlier so why? number one you and I all do desire to be treated in particular ways or at least have specific people to make decisions for us in our incapacity should we have the inability to do so if we do not have people specifically designated or we do not have general ideas about what we want done to us then we have no assurance we'll be looked after by those whom we desire to have look over us for example you might be married and your spouse is a jerk or an unbeliever or something and in the state in which you reside that person has control of your medical decisions should you not give it to somebody else or let's say that you are the oldest child of a family of seven your parents are both dead and you go into a coma the question is who has the ability to make the decision well let's say that technically it's the oldest other sibling but that sibling lives out of state and the sibling that does live in state doesn't show up and everybody's on the phone fighting over who and what to do about you except for the three people that don't want to have anything to do with it and just say don't call me it's a gigantic disastrous mess ask anyone in the medical field who's been around for a while you'll quickly learn that it is often not a pretty scene when these kinds of situations arise because of the incredible amount of jockeying for control of decisions there is in a family remember this even if your spouse is in charge your parents or your spouse's parents or your children or great aunt Betty who ain't got nothing to do anymore is going to be giving their advice regardless of the situation and unless there is something that you can say I'm in charge here's what we're going to do generally or specifically then it's just going to be a free for all so it is actually unloving towards those whom you love to not have something like this because it allows for human nature to work at its worst the best comparison I have to this is a church constitution is having a church constitution something we can proof text from the word of God yes or no? this should be an easy answer no, that's right no, there is nothing in there however are the principles behind which we have a church constitution biblical, yes or no? I hope so since we have one what would those principles be broadly speaking? huh? order? that's right what else? yeah, so overseers know who the flock is that they're actually watching over what about who humans are by nature? what is having a constitution that we speak to in that realm? what are you by nature? sinful therefore, by having a constitution we are recognizing that without some kind of order around here we will most likely devolve into chaos Jeremy Wise hope community church as peaceful as it seems to be at least from the outside there's a lot of reasons for that one of the big reasons is we ain't got to fight about the way we do a lot of things around here the main real important thing is to lay it all out because we just want to we are recognizing that we are sinful human beings that are messed up and ordinarily disasters add to this idea of people fighting with each other and then you have the person themselves who is trying to make the decision so even if I don't have 54 family members giving me advice I have still got to if the doctor comes and goes and know this a lot of times if the doctor doesn't come and go alright listen we've got 17 weeks to figure out treatment for the person that you are in charge of okay, so I want you to go home I want you to go on the internet I want you to talk to 57 of your best friends I want you to seek the counsel of your pastor that rarely happens you know what happens a lot of the time you got 3 seconds yes or no what are the you know ins and outs well, we've got a pretty decent chance of doing this we've got to go now and you're the one that makes the decision again, you go this is not fun stuff to think about you know what it's going to be a lot less fun when you call me because you haven't thought about it now or you call brother, sister, so and so and go I don't know what to do it's worth thinking about we must think about these things now here's the third thing and this is the thing we might not think about it's an incredible benefit to the art of living well to think hard about dying as we've seen filling out a document like this forces us to think hard about our own tragically inevitable end these decisions should not be made on a whim they are binding this is something you have to know I signed this document I assigned Marge as my agent I have Andy and Hadassah be the witnesses to that as long as Marge has a copy of that document she makes the decisions even if I'm like oh shoot I don't want her to make the decisions we got in a fight yesterday over whether ice cream snickers bars are worth eating or not and she is super ticked off I know she just wants to see me go she still gets to make the decisions it's a thing worth fighting for by the way the answer is no this thing is disgusting next you and I clearly have to be able to talk to our agent but we'll also have the blessed opportunity of talking about our death with others you shouldn't just make these kinds of decisions like let me think about let me think about how I want to die ok I'm going to make that decision you need to talk about this with other people you want to get to know your fellow brothers and sisters in the church start talking about your own death right like what do we do when you know we have so and so over it's going to be so awkward and weird you're like I know let's make it a whole lot more awkward and weird let's be like hey listen I'm thinking about my own death how do you want to go out that would provide for deep and stimulating conversation and I'm not even joking right it really would be like man I haven't thought about this I know I'm going to die I know you're going to die how do you want to die why I'm in no way saying the Bible demands that we have advanced directives or power of attorney for health care I'm definitely not demanding that we do so but I do wonder why you would willingly reject having something like this and putting others through this kind of burden it might not be pleasant to do but I hope we can see why pursuing these kinds of things is a way of wisdom now there is this question of well who should my agent be and the answer is I don't know I don't think that it necessarily has to be anybody in particular now if for example you you are married and then you're like I don't want my spouse to be it and the answer is like if you're married and like your member is here then like you should probably talk to somebody that's probably a glaring sign that there's something tragically wrong in your relationship you might have a good reason like the one that I talked about at least one that maybe makes sense to you like well if Marge and I both get in a car crash then I don't want Marge to you know well you can still have a second behind that but do I have to have that person no not necessarily or do I have to put like my mom or something no it might very well be that somebody is married to an unbeliever and they're like I I don't think Christians inherently make good decisions but I'm just terrified of what my husband or my wife would do I don't trust them I would like to trust them but I don't trust them I can't have them as my power of attorney or my person who's in charge of my living will it doesn't have to be anybody in particular you darn well better pick somebody that you think you can you think you can trust it is true that it is somewhat of a burden on those who will willingly serve as our agents you can't force anybody to do this but it should be a burden our agents ought to take on with joy because it's an act of love towards you and regardless of whether we have one of these two two we have one of these things or not regardless of how specific it is or how general it is it's not as if you just simply fill this thing out and then you're done you file it away like you do your taxes right like most of you have done your taxes except for those of you who are extremely you know something other than diligent but most of you have not thought about your taxes since the day that you filed them whatever that can't happen when it comes to advanced directives or power of attorney for medical purposes because simply put especially if it's general like I argued probably should be this person doesn't only need to know okay yes or no black or white check it off right tube feeding do you want that no okay no because you think of the situation in which tube feeding might be appropriate after a surgery where you're going to have a high likelihood of recovering maybe not obviously but yeah high likelihood of recovery it's like for some reason you cannot eat physical food and you're also like you know incapacitated or whatever they're like yeah we're putting you in a medically induced coma and so you know and you're like she does not want that let her go and thankfully depending on the state the state's not going to let you go like oh okay yeah all right we'll medically induce her into a coma and then you can just say no artificial means of feeding so she's going to die this is great let's go with the procedure that can't happen we should be thankful for that kind of thing however you need to continually talk with the person because even if you had the Russian novel 8,000 page here's every little thing I want done I guarantee you that there's going to come some point where it's like well actually X I don't even know what X is could be the factors are crazy and unless let's say you're my agent unless you know me then how are you going to possibly know what I would want it sounds really good to be like well I've got this piece of paper I'm just going to refer back to this piece of paper there it is subsection 42 part F this is what I do it's much more who is this person what does this person want and again you go well this is so creepy I don't want to think about my own death it would be better because you're going to die me too and what better way to think about living than to go there is a limited number of days that I have it might be a long number it might be a very short number but it is thinking limited no matter how many days how many days I've got and by thinking about these things then I am truly talking about what kind of life I would like to live the life unexamined is not worth living right it's a true statement it's always been true and by doing this we're actually observing our lives closely thinking about the kinds of lives that we would like to live so I would encourage you again not force you not demand not tell you not exhort you even I would ask you to consider these kinds of things any questions before we end did I answer your question maybe did I answer your question great okay good yeah yes yes nope they have to do those things yeah unless you had written extra stuff under the additional provisions list and both of those things have additional provision sections yeah I mean both any hospital will have it you can get them online though you just search the term they are the power of attorney is not state specific available in our state and then the the living will or the advanced directive is state specific so you search it I can send you the link if you want it it's easy to just google it too either of those so I would at least I mean encourage you just take a closer look at it think about it pray about it again you're gonna die and me too so this is not something that's just kind of like and I would guess that this would be one of the kinds of things that having thought about this for a minute and then gone I'm gonna not do that would be one of those things that you would probably look back on rather kind of with regret should you be forced in a situation where making these kinds of decisions is possible and you delay it or just put it off so I encourage you for your own good for the good of those who love you to think about it so let's pray the practical bits of dying well are not easy to think about not very fun sometimes but I hope as we've seen it is truly an act of wisdom towards ourselves and love towards others to think well about our own death what that is going to be like how we would like to be treated and why we would like to be treated in those ways as we've seen even with just this short overview of some of these things there are some rather maybe simple things that we could say yes or no and there's also some very disturbing things that maybe we've never even considered that people would have the ability to do or we would have the ability to do I pray that as we think about these things going down the road that we would make these decisions focusing not only on what we will do but why we are doing what we are doing that we would see these acts of considering these kinds of things or pursuing these kinds of things as true acts of building either virtue or vice depending on the basis of our actions and on the basis upon which we make these decisions so I pray that you would help us to make good decisions I pray that we would realize that by thinking about our own deaths and thinking about them profoundly we would understand maybe in a better way the glories of living life today I pray these things in Jesus name Amen