The Register-Herald, Beckley, West Virginia


April 13, 2014

Decision day

It’s time to make time for advance directives

Pastor Roger Pauley and his wife Marcia were — like so many other baby boomers — charged with the responsibility of making decisions for their aging parents. For the pastor’s father, death was sudden.

“There weren’t any decisions to be made,” Pauley recalls. His father-in-law, however, was a man who had time to think about what he wanted at the end of his life, and he talked freely with his most trusted confidants, his daughters, about it. Whenever admitted to the hospital, where he was asked if he had advance directives in place, his reply was the same: “My girls know what to do.”

Luckily, when it came time for him to pass, his daughters did know what to do. Marcia and her sister were able to make the right decision because he’d had the conversation with them repeatedly, the last time only a week before his death.

“Dad wouldn’t want that,” Marcia’s sister said when asked if the family wanted him on life support. “Dad had three pacemakers (placed) in 30 years,” Marcia explains. “He had told us when the time came, he’d done all he needed to do —  he knew where he was going and didn’t want to be on a machine or kept alive artificially. He didn’t fill out the form because he trusted us.”

As pastor and pastor’s wife of Cranberry Baptist Church, the Pauleys regularly encounter families facing tough end-of-life decisions. Not everyone is as open in communicating wishes explicitly, like Marcia’s father. To avoid families being faced with decisions on behalf of mom or dad, parents should complete their advance directives — for themselves and their loved ones.

National Healthcare Decisions Day is Wednesday, April 16, and Raleigh General Hospital, Beckley, will open doors 9 a.m. to 3 p.m. to the public for those interested in learning more about advance directives or who are ready to prepare them at no cost, with the help of a social worker or medical professional and a notary.

Says RGH Education Coordinator Kathy Bailey, “We really want to educate everyone that they should have the discussion while they are relatively healthy and able to make good decisions.” Bailey credits  Dr. Marcia Khalil with championing the cause of educating the public about advance directives — making their wishes known so family members have the confidence and courage to carry them through when it counts.

Advance directives are legal documents completed by a patient, sometimes with a physician or social worker, describing the details of wishes for end-of-life care. Advance directives include a living will (a document describing healthcare, not financial decisions), a durable power of attorney designating someone to make healthcare decisions on your behalf should you become incapacitated, DNR (Do Not Resuscitate) orders and the POST form, or Physician Orders for Scope of Treatment, a detailed health care directive to be completed alongside a physician.

Whenever patients enter the hospital for treatment, they are asked if they have advance directives in place. Sometimes, patients misunderstand the benefits of the safeguard or prolong thinking about it, resulting in an average of only 20 percent of the population having executed an advance directive and only 50 percent of terminally ill patients officially making their end-of-life decisions known.

Dr. Angela Pendleton who helped with the National Health Care Decisions Day at RGH last year noticed the hesitancy of people misunderstanding the intent of advance directives. “We had a couple of people filling them out and they wrote: ‘Do not let me die’ in the margins.” Pendleton emphasizes the point of advance directives is to have the conversation —  before a car accident or before cancer — and not only with a family member, but with a physician.

With any advance directive, Bailey says the rule of thumb is ‘cure sometimes, but comfort always’, indicating if something reasonably can be done to save a patient’s life, then it will be done. But there’s a difference between saving a life and prolonging an impending death.

Would a person want artificial means of providing nutrition, like IVs and feeding tubes, if organs were shutting down and there was no way of processing substances? Would a person want to be resuscitated if death were imminent and unavoidable, kept alive by artificial means? The answers can’t be right or wrong -- they depend on the person answering. The important point is communicating wishes before family members are left to play an agonizing guessing game.

“(With advance directives), the intention is that whatever the patient wants will be carried out. (As with the POST form), they can be very specific,” says Vicki Silosky RN, BSN. She adds for clarity: “A living will does not even become effective until (a person) is in a terminal or vegetative state.”

The conversation, maintains Marcia, needs to happen for an ending to be truly peaceful, not only for the person, but for those left behind. “Speaking as a child of someone who passed away, (advance directives) make it easier for the family —  to make sure you’re doing the right thing for your parent,” she says.


For more information about National Healthcare Decisions Day, visit

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