by Jennifer Scoggins, CLA
At last check, the subject of dying was not high up on the list of topics to discuss over Sunday dinner with the family. In fact, most attempt to avoid discussing it regardless of the venue or timing- simply, there isn’t anything “fun” or pleasant to attribute to the subject. Yet, while we all have an aversion to contemplating the realities of death and the idea of our own mortality, much less that of our loved ones, it is more important now than ever before that we engage in discussions regarding these matters and make plans for how we want to handle the inevitable, sooner rather than later.
In his November 2011 TED Talk, “Dying in the 21st Century”, Dr. Peter Saul stressed that indeed, it DOES matter “how we die”. Dr. Saul, who is Senior Intensive Care Specialist in the adult and pediatric ICU at Johns Hopkins Hospital, as well as the Director of Intensive Care at Newcastle Private Hospital, Australia, has experienced first-hand the stressors that death, and all that it involves, places upon the individual, but more so that which is suffered by their families after the fact. In this modern time, more often than not we die from frailty, or the dwindling of capacity; in fact, Dr. Saul estimates that 6 out of 10 die from simply “old age”, making it the leading cause of death in society today. Indeed, as humanity achieves innumerable advances in science and technology, we live longer as a result- thereby lessening the abilities of intensive care and emergency units to “save patient’s lives”, as less and less remains that CAN be done given the circumstances. Unfortunately, while once considered as an option for the extremely wealthy, hospice care has become far more mainstream as a result.
After a number of eye-opening experiences, Dr. Saul became interested in what he termed as “patient choice”. A review of the records of 4500 nursing home residents indicated that one out of one hundred patients had a plan in place for their death, while only one in five hundred had a plan in place in the instance of serious illness. Further, upon reviewing hundreds of doctor’s notes included in patient’s records, he found not a one that mentioned a discussion with the patient regarding their goals, desired treatment outcomes, and what the patient’s expectations were in the event the treatment course was unsuccessful. All the more intrigued, Dr. Saul and his colleagues at Johns Hopkins initiated a study called “Respecting Patient Choices” in an effort to determine specifically how individuals would respond to the invitation to discuss their deaths, i.e. what their preferences would be were they able to make a number of decisions about the process in advance of it transpiring and how involved they might be willing to be to bring their decisions to fruition. The study was approved for government funding, and soon thereafter volunteers were sent into the hospital wards to initiate these discussions. Not surprisingly, 98% indicated that they appreciated the opportunity to make these choices on their own, in advance of it being too late, and agreed that is how it should be. Interestingly enough, despite the study’s success, once the funding ran out, the discussions stopped, as well, and matters returned to the previous norm. The study was successful, regardless, as it proved Dr. Saul’s hypothesis- it matters how we die.
The single most important document one can have at any given moment of their adult lives is an Advanced Healthcare Directive (AHCD). An AHCD (also known as a “living will”, medical power of attorney or medical directive) is a legal document that provides specific guidelines and directions to loved ones when making difficult medical and end-of-life decisions, i.e. those while the patient is incapacitated and unable to effectively communicate their wishes, or in some circumstances, no longer capable of making those decisions on their own. It can cover a wide range of situations: directions for caregivers in the event of dementia or illness; treatment, testing and surgical options; where and when to receive care, and from whom; or pain management and palliative care. It also directs end of life decisions, such as whether or not to prolong life, organ donation and one’s funeral wishes. In the absence of an AHCD, the family may find themselves fighting over what each individual feels their loved one wanted, or would want, had they been able to say themselves; not only can this cause irreparable harm to the family unit during a painful and emotional time, but without clear direction from a family member and the appropriate legal documentation, the health care provider MUST take any and all steps available to prolong life- even if that is not what the patient would have wanted.
The most important part of one’s AHCD is the selection of one’s agent- the person named to act your behalf when you are unable, consistent with your wishes. The agent plays the role of advocate and decision maker, as well as director. In determining who you would choose to be your agent, two questions are key: first, who would you like to speak for you if you can’t? In essence, who do you trust implicitly to know you well enough to be able to make finite decisions for you, based upon that knowledge? Secondly, have you spoken to that person about what is important to you? The answers to these questions are the first step in creating your AHCD.
The second step is contacting an experienced estate planning attorney who can discuss your wishes in depth with you and create an effective, legally binding ACHD that protects not only you, but those that you love the most, providing the gift of peace. While we cannot control whether or not we will die, we can control how we die. Please contact us today for trusted, experienced advice and guidance in creating your AHCD.