Unfortunately, it sometimes takes a terrible tragedy to remind us all to do the right thing. Recent events in the news have done just that for many of us in the financial planning community.
Sure, we may talk about estates and wills, long-term care, budgeting, investing and a million other aspects of maximizing you wealth for you and your family, but sometimes we forget to talk about the really hard stuff like the “D” word. “D” of course stands for death and, while we talk about wills, sometimes we forget what are generically called “Advance Directives.” Advance Directives are instruments that let your family know what your wishes are in case you can’t communicate and that’s what we will talk about this month.
First, let’s talk about what we mean by “being fair” to your family or perhaps we should talk about what we don’t mean. Nothing in this article is intended to say you or any other reader has been unfair to your loved ones if you haven’t established an advance directive. It’s quite possible you never thought about it and, even if you have thought about the subject, it’s pretty hard to say exactly what you will want or do in any given circumstance. Let’s face it, writing a will is a pretty tough reminder of your mortality to begin with, but telling someone you want the plug pulled is an even greater challenge.
What we hope you will come away with from this article is a greater appreciation of 1) how hard the decision to withhold “heroic” treatment will be for your loved ones and 2) how you can ease their burden with a few simple steps. Therefore, we would define the process of being “fair” to your family one where you decide what lifesaving measures you want in case you are terminally ill and then communicating that with them, even if you tell them you honestly don’t know.
You may wonder what this article is in a financial planning column for. We will answer that with a short story. There once was a fellow named Steve. He was in his forties and needed a heart transplant. When this story takes place, a typical heart transplant cost $150,000 up, depending on complications. Steve was an executive and had saved enough to get the kids through college and, together with his life insurance, provide a modest living for his wife after his death. He asked the health insurance company if they would pay for the transplant and they wouldn’t give him a definitive answer. Steve refused the transplant because he did not want to risk putting his family into financial difficulty if the insurance company refused to pay.
As you read this article, remember one thing - with the potential level of care a terminally ill patient may need and the horrendous cost of healthcare, every
healthcare decision you make can have far-reaching financial consequences.
Ok, so what is are advance directives? Advance directives are legal documents that allow people to make their own decisions on how they wish to be treated when end-of-life care decisions must be made. End-of-life care is the level of medical care given to a person who is in and advanced stage of a terminal illness and, for our purposes, a terminal illness is any medical condition where the only way you will stay alive is to be kept alive by artificial or mechanical means. It is important to note that in such a case, we are talking about a situation where you are no longer conscious or responsive.
The common types of advance directives are 1) living will and 2) health care proxy and durable power of attorney for health care.
A living will
gives direction to your legal guardian and the hospital staff on what medical treatment you wish to be used to keep you alive. Generally, a living will contains guidance about the following:
- Use of heroic measures, including utilizing mechanical life support like dialysis, ventilators, etc.,
- “do not resuscitate” orders preventing the use of CPR and other measures if your heart or breathing stop,
- use of artificial hydration and feeding,
- palliative (comfort care) and,
- donation of organs and tissue.
Even if all the measures are in place to prevent the use of artificial means to keep you alive, this does not mean that all care is withheld. Palliative care is care that is meant to keep you as comfortable as possible until you die. As long as the goal is to keep you as comfortable as possible and not to extend your life, there are numerous treatment options available.
If you decide to use a living will, remember to discuss it with your family. Most states require the living will be witnessed in order for it to take effect. Generally, the witness(es) cannot be family members. Once executed, you should make copies of the living will and make sure it is distributed to anyone who might have an interest in your health care decisions.
A health care proxy
is someone who is empowered to make medical decisions for you if you cannot or chose not to make such decisions for yourself. Essentially, this person becomes you for purposes of determining your level of care. The durable power of attorney for medical care or medical power of attorney
is the instrument that designates the health care proxy. Since this person will have control over your health care, you will want to appoint someone you literally trust with your life. While their powers will be far-reaching, if you are not terminally ill or in a permanently unconscious state, the one thing your proxy cannot do is authorize the withdrawal or withholding of life-sustaining treatment. If, however, you are terminally ill or in a permanently unconscious state, then your proxy can make all decisions for you, including withdrawing or withholding life-sustaining treatment.
At first glance, you may say there is not much difference between the living will and the medical power of attorney, there is a great deal of difference. The living will basically removes the burden of making a decision regarding your care from your family or a doctor. Since it is more or less a directive, the family is bound to follow your wishes. The medical power of attorney, however, places someone in a position where they will be forced to make a decision for you. Should you choose the medical power of attorney, be certain that your proxy knows what decision you would want made.
There may also be situations where you would want both a living will and a medical power of attorney. For example, you may have a spouse with Alzheimer’s disease. If you are in an accident and are unable to make medical decisions, but the injuries do not meet the criteria to invoke your living will, you wouldn’t want your spouse to be your decision maker. In an situation like this, naming a trusted friend or family member as your proxy would provide the decision making authority for the medical team needs and prevent a third party who doesn’t know you from making a decision you may not agree with.
Medical advances are made everyday, and sometimes those advances can cure what was once thought to be an incurable disease. On the other hand, those advances are little more than another way of sustaining life when there is no reason for further heroics. The tragic events in Florida of the past few weeks point to the fact that there is only one person who can make the right decision for you. That person is you and we urge you to take the time to prepare and discuss an advance directive that is right for you before it is needed. Be fair to your family and to yourself. Honestly discuss your wishes while the choice is still yours.
On that note, have a great November and don’t forget those fighting for our freedom.