How to Help Clients Preparefor End-of-Life Decisions
By Emir Phillips
March 18, 2014
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“My grief, I find, is not desolation or rebellion at universal law or deity. I find grief to be much simpler and sadder. … All the things he loved tear at my heart because he is no longer here on earth to enjoy them. All the things he loved!”
– John Gunther, Death Be Not Proud
End-of-life decisions should be addressed by all financial planners. People are dying more from chronic illnesses, and deaths are increasingly occurring in institutions, where individuals and their families may incur significant expenses. Those costs could be substantially mitigated with proper advance-directive planning initiated and guided by a caring financial planner.
The alternative is to rely on a primary physician, who is not paid to provide financial guidance for these delicate decisions and may not be competent in doing so.
A competent financial planner must:
- Understand advance directive’s formal requirements
- Know how decisional capacity is determined
- Judge when advance directives should take effect
- Understand the rights and responsibilities of healthcare agents and health providers
- Comprehend the limitations of decisions to decline life-sustaining treatments
Given the limited value of living wills, I recommend the importance of appointing a healthcare agent, which promotes requisite flexibility and discretion.
An advance directive is a legal document to determine the course of care and treatment when the client is terminally ill, permanently unconscious, or in a coma. An advance directive can be any statement given in advance of decisional incapacity. Most advance directives include two components: a “living will,” which is written instructions for end-of-life medical care, and designation of a health-care power of attorney (usually a family member) to make end-of-life decisions. A power-of-attorney for healthcare names someone to make decisions on the client’s behalf, whereas a living will provides instructions regarding the extent of the medical treatment clients want to receive. These two essential advance directives are authorized by statute in every state. Many of these state statutes (sometimes called “natural death acts”) are modeled on the Uniform Health Care Decisions Act adopted by the National Conference of Commissioners on Uniform State Laws in 1993.
Though the living will was the first type of advance directive, in 1967 the Euthanasia Society of America1 developed the healthcare power of attorney, which has become the preferred and most widely used directive. This simple-to-use advance directive permits someone else to make decisions for incapacitated clients in a way that faithfully represents the decisions they would have made for themselves if they were able. This substituted judgment averts many of the pitfalls from interpreting living wills. Too often, living wills are written years before they are needed, which is why healthcare providers can find a living will’s instructions too broad or too narrow to provide useful guidance in a specific clinical situation. Thus, critically ill patients frequently receive more aggressive medical treatment than they had earlier said they wanted.
1. Kutner, Luis. “Euthanasia: due process for death with dignity; the living will.”Ind. LJ 54 (1978): 201.
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