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Preparing for the Inevitable: End of Life Decisions

My Dad broke his hip two weeks ago. After he was admitted to the hospital, I had the difficult but important conversation with his treating physician regarding his end of life wishes. As his agent, it was my job to reflect his wishes to the doctor, that no extraordinary life sustaining measures be taken in the event he were to go into cardiac arrest, for example, during his course of treatment.  He is nearly 79 years old, bedridden, in daily severe pain, and has cognitive impairment.  It was a clear decision because I know my Dad and what he would want given his current condition. I feel the same way about my person, and have that documented in my own Advance Health Care Directive.

As an estate planning attorney, I address the topic of Advance Health Care Directives (often referred to simply as Advance Directives) with all of my clients.

Preparing for end of life, as described in an article from The Herald-Mail titled “It’s never too early to prepare for the end of life,” needs to include emergency situations, where decisions about life-saving measures must be made, usually by family members who are often not prepared.

Spare your loved ones from the agony of making decisions, based on what they think you might have wanted by planning in advance for what is, without question, unpleasant to consider. Nevertheless, in today’s era of medical technologies, such scenarios are quite possible. Let’s start with the advance directive.

Advance Directives are legal documents that include both a living will and medical power of attorney. The living will allows you to document your specific preferences for medical care at the end of life. These range from aggressive intervention that saves your life, to palliative comfort care that gives medication to alleviate pain and suffering but does not take heroic measures to save life if something happens (like we did for my Dad). There is a wide range between the two, so the more specific you can be, the better your loved ones will know what you want.

A medical power of attorney lets you designate a trusted person—spouse, friend or adult child—to make decisions for medical care, if you cannot do so. This is also known as a health care surrogate or proxy.

Here’s what happens when no advance planning has occurred. A critical medical situation arises, and family members are contacted. Without having had a discussion about the person’s wishes, typically an aging parent, siblings don’t know what to do. If they do know what to do, but there is no legal document attesting to their parent’s wishes or if the legal document is not physically present, the medical provider is bound by their own determination of the situation and their professional code of ethics.

That action may not be what you would have wanted. However, your family or trusted friends do not have the right to make decisions, if legal documents are not in place. The solution is relatively simple: plan in advance.

First, give serious thought to what you would want to occur. Make a list of questions to discuss with your primary health care physician.

Second, have a conversation with family members and friends about your wishes, and discuss with them their role in such situations. Are they willing to carry out your wishes and to take on this responsibility?

Third, meet with your estate planning attorney and prepare the necessary documents. While you’re doing that, review your estate plan to ensure that your end-of-life wishes, and overall estate plan are aligned.

Reference: The Herald-Mail (Oct. 8, 2018) “It’s never too early to prepare for the end of life”


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