End of Life Decisions” - October 25, 2009

One positive result of the national healthcare debate is that it has Americans talking about many facets of healthcare. Even such red hot topics as ‘death panels’ have encouraged conversations about end of life issues among folks who before would never breach the subject.

In last week’s column, I offered a five-question quiz that would help you decide if you need estate planning. The first question was, “Do you have an Advanced Directive for Healthcare?” With current advances in medical science, doctors and hospitals have the ability to keep someone’s heart beating way beyond the point where there is any quality of life. Without specific directions from the patient, the physician and hospital face the awkward dilemma of deciding to what extent to allow medicine and machinery to keep a patient alive. The decision to continue life-sustaining treatment can literally devastate families from a financial perspective. Current medical insurance policies typically have provisions for both co-pay and lifetime limits which can quickly exceed a family’s ability to pay.

The best solution? Decide now, while you’re healthy and of sound mind, exactly what level of care you wish if you were to end up in a vegetative state, terminally ill or in a coma with little chance of recovery. Fortunately, every state government has made this easy for you by developing a fill-in-the-blank form for making these types of healthcare decisions. It’s commonly referred to as an Advanced Healthcare Directive and consists of two directives:

Living Will. The Living Will portion walks you through a series of situations and allows you to say what level of care you would prefer. For example, if you are unable to feed yourself, would you want a feeding tube? Or, if you cannot breathe on your own, do you want to be on a respirator?
Medical Power of Attorney. As you might imagine, a single document such as the Living Will cannot address every situation that might occur. You’ll need someone to speak for you in situations that are less clear. In your Advanced Healthcare Directive, you will appoint someone to fill this role known as your Attorney or Agent for medical decisions. Choose this person wisely and be sure to have a detailed conversation about the level of care you want. They’ll need to be strong enough to stand up to doctors, hospital administrators and family members who may have a difference of opinion. You’ll also need a successor agent should your first choice be unable to serve.

I realize that end-of-life planning is not a typical topic for dinner conversation and most people would rather avoid it altogether. But to do so, may very well put your family at risk of financial ruin and create a divide between family members who have a difference of opinion about the level of care they think you would want. My recommendation is to deal with the issue now and commit to revisit it periodically. To download the Advanced Healthcare Directive fill-in-the-blank form for your state of residence, visit the Resource Center at www.welchgroup.com; click on Links, then Living Wills- State by State.