Healthcare directives and powers of attorney
For many people, end of life healthcare planning occurs when they sign an advance directive to physicians. The directive essentially tells your doctor what kind of care you want (or don’t want) when you can no longer speak for yourself. Attorneys and long-term care insurance providers agree that having an advance directive is smart. It can save your estate a lot of money and, perhaps most importantly, it can save you suffering when you’re near death. But a directive isn’t always enough.
The danger of cookie-cutter directives
Dr. Jessica Zitter, a critical care and palliative care physician in Oakland, CA, recently published an insightful article regarding one nightmare scenario. Dr. Zitter’s patient, called Vincent, was an old and very sick man that lived at a nursing home (at least when he wasn’t at the hospital). Vincent had executed, and later amended, an advance directive that required his doctors to do everything possible to keep him alive. Vincent was admitted to the ICU on nine separate instances near the end of his life. On his last trip, his hip bone was entirely exposed due to chronic infections, ulcerations, and lack of skin and tissue.
The details in Dr. Zitter’s account of Vincent are startling, but perhaps more startling is the possibility that nursing home provided advance directives, which are “cookie cutter similar,” are geared towards misaligned objectives. According to Zitter, “nursing homes typically highlight advance directive completion rates as a point of pride, a metric to prove that they are concerned about the patients’ preferences.” That may be true, but Vincent’s directive didn’t stop his disastrous final weeks/months.
Casey Kasem’s end-of-life nightmare
Another legal document, called a Healthcare Power of Attorney (HPOA), can help ensure your final medical wishes are followed. A HPOA appoints an agent to speak to your doctors for you. But even when a person has both a HPOA and a physician’s directive, there can still be a dispute regarding care. Such was the result for Casey Kasem. Mr. Kasem’s final days, which got national media attention, involved a court battle between his daughter (Casey’s appointed healthcare agent) and her step-mother (Casey’s second wife). In the end, Casey’s daughter prevailed, but it didn’t stop the delay and fighting between his family members. Sadly, this scenario plays out too often (without media coverage).
Little can be done to entirely stop family member intervention. Your death will be overwhelmingly emotional for everyone in your family. And unfortunately, the emotions don’t always point to the same objectives or decisions. But there are things you can do to help avoid a nightmare for yourself (and your family).
What you can do
1. Have a Physician’s Directive and HPOA. Have an attorney help you – these aren’t costly and can be done quickly. You’ll sleep better (and maybe even live longer) having them done.
2. Designate an agent that you trust and expect to be up to the challenges of carrying out your wishes. Your death won’t be easy on your family, so choose someone who will be up to the decision making challenges (while also being compassionate with the others).
3. Communicate with you family about what you want. If you have an aging parent, encourage them to talk about what they want. It’s a difficult conversation but it’s very important. Ideally, you should have the conversation with all of your family members together – that way your family members can be assured that you said the same thing to everyone. Also, your conversation should align with your directive and HPOA.
4. Finally, update your directive and HPOA as your life circumstances change. Your attorney can tell you more about recommended updates.