Excuses, Excuses… Why You Don’t Have a Healthcare Directive
January 20, 2011
What is keeping you from signing a healthcare directive?
A recent article in Reuters mentions that only 2 out of 5 U.S. citizens have some kind of healthcare directive, and that our own U.S. laws might be the cause. A study done by Rebecca Sudore of the University of California, San Francisco found that “Most states had practical restrictions that could make it difficult for many people to complete an advanced directive… In addition, many of the documents used in end-of-life planning were written in complicated legal language that the average person would have trouble understanding.”
Some portions of an advance directive might be written in complicated legal language out of necessity, but we don’t think that’s any excuse not to have one, especially not if you have a knowledgeable and trusted attorney who is willing to go through the legal language with you to ensure you are comfortable with it. As for the other obstacles, the fact that “many states do not allow oral advance directives, and usually require that written documents have witnesses’ signatures, be notarized, or both…” and that currently “40 states do not automatically allow domestic partners and same-sex partners to become the default healthcare proxy;” well, these seem to us to be all the more reason to make sure you DO contact your attorney and get your healthcare directive in place.
A healthcare directive, along with a will and a durable power of attorney, are the three foundational documents of any estate plan. Whether you choose to move on to more advanced planning techniques or not, every person should have these three documents at the very least. These simple documents can end up saving you and your family a world of heartache and expense.
Of course, according to Reuters there is one other possibility about why you might be putting off your healthcare directive, “The biggest issue is that people do not want to do advance directives… There is a fear of planning for how we die.” Don’t let superstition keep you from protecting yourself or your loved ones.
Ensure Your Wishes for Medical Treatment are Followed: Share Them With Your Doctor
May 18, 2010
This time of year often involves spring cleaning for many families: reorganizing the closets, clearing the weeds and brush from the yard, and getting rid of all those boxes in the garage or basement. Spring seems to be a time to take stock and start fresh… at least in the home. But what about with your health?
We’re not talking about the diet you vowed to follow in your New Year’s Resolution, or trying to look good in that new bathing suit for summer; what we’re talking about is your annual checkup—taking stock of your health with your primary care physician and making sure you’re both on the same page with your instructions for health care and your advanced healthcare directive or living will.
When clients come into our office for an estate plan, we ensure that their healthcare instructions are completed as well; but the job doesn’t end when the document is signed. Your health care providers need to be aware of your wishes as well. The best way to ensure that they know and understand your wishes is to take a copy of your advanced healthcare directive or living will with you to your next check up and talk to your physician about it, then ask them to keep the copy on file.
A rule of thumb with healthcare wishes is to give a copy of your living will or healthcare directive to each of your primary care physicians, give a copy to each of the healthcare agents you’ve nominated, AND keep a copy or two on file to take with you if you ever need to go to the hospital. And of course keep the signed original in a safe place with the rest of your estate planning documents.
What Does “Do Not Resuscitate” Mean to You?
January 29, 2010
Everybody seems to know (from popular TV shows, if nothing else) that DNR means “Do Not Resuscitate”, but do you know what “Do Not Resuscitate” means in your own personal healthcare directive or living will? Too often, when talking with clients about the healthcare documents in their estate plans, they don’t know the extent of their own (or their parent’s or grandparent’s) instructions.
“Do Not Resuscitate” can cover a wide array of options, which is why it is so important to define what “life-saving procedures” means to you, and exactly when you would like your DNR to go into effect. Here are some examples of “life-saving procedures” that you (or your elderly relatives) should talk about with family, medical staff, and your estate planning attorney:
Artificial Nutrition and Hydration When grandma decides to stop drinking fluids orally and begins to dehydrate, does the nursing staff have permission to keep her hydrated via IV fluids? What about if you are in a non-reversible coma and unable to drink liquids on your own?
Antibiotics or Other Medicines Do you include antibiotics in your definition of “life-saving procedures?” Do you still if you have been declared irreversibly brain-dead by two independent physicians? When you are 102 and confined to a bed in a nursing home, do you want to be given medicines to combat pneumonia or other illnesses?
Chemotherapy A point similar to the paragraph above; if you are 102, afflicted with dementia and confined to a bed, do you want to receive expensive and painful chemotherapy treatments if the doctors discover cancer?
Blood Transfusions Blood Transfusions are fairly universally considered “life-saving procedures”, and they should be addressed in your healthcare documents. Do you have religious reasons for refusing a blood transfusion? Do you still want one if you are severely and irreversibly disabled?
Organ Donation Though obviously not considered a “life-saving procedure”, organ donation is a topic you should discuss with your family, medical providers, and estate planning attorney to prevent any misunderstandings or delays in treatment if and when the situation arises.
A healthcare directive is one of the most important documents in your estate plan. State-specific healthcare directives or living wills can often be found for free online or at your doctor’s office, and in a pinch these will work; but they cannot take the place of a conversation with a knowledgeable estate planning or Elder Law attorney who will ensure that all aspects of your decision-making process are addressed and put down in writing. After being discussed and incorporated into your Advance HealthCare Directive, you should then discuss them with your agent, which is usually a member of your own family. Be proactive in this effort, and it will save grief for the family and help ensure that your wishes are followed.
The Consequence of Silence
April 10, 2009
The second annual National Healthcare Decisions Day is coming up on April 16, and there has never been more reason to consider what your own wishes are, and especially to make those wishes known. As difficult as it may be to think about the end of your parent’s, your child’s or your own life, not doing so—and not talking about it—can have unintended consequences.
According to Maggie Jones, studies conducted by researchers at the Dana-Farber Cancer Institute revealed that not discussing your end-of-life wishes with your doctor is likely to lead to a more expensive death, a more painful death, and a more traumatic experience for your loved ones… the only thing it did not lead to was a longer life.
Talking about death and your end-of-life wishes does not have to be a difficult or painful conversation, especially if you don’t wait until the last minute. Dr. Anthony Back encourages people to “pace themselves by having ongoing end-of-life discussions, rather than waiting until there’s only time for one big, emotionally loaded conversation when the patient is near death.”
At our firm we agree with Dr. Back. We discuss your healthcare and end-of-life wishes during our planning sessions whether you’re 82 or 28, and we include your wishes as part of your estate plan by encouraging you to execute a healthcare directive as part of your plan.
The Most Important Part of Your Estate Plan
April 7, 2009
What is the most important component of an estate plan? This is a question that comes up a lot in our practice, and as you might guess, different families will have different answers.
The Trust: Many families feel that this is the heart of the estate plan, and as such the most important part. As the document that outlines your wishes for distribution amounts, designates beneficiaries, nominates trustees, defines your incapacity and lists your assets—there is definitely reason to think the trust an important part of your plan.
Healthcare Directive: Some people are more concerned with how their end-of-life wishes are carried out than with the distribution of their estate. Those people consider the healthcare directive—the document that sets out your wishes for medical treatment, resuscitation, and healthcare agents—the most important component of an estate plan.
Guardianship Documents: Parents of young children are often more concerned with the guardianship portion of their estate plan than any other portion; they trust that as long as their children are in the hands of loving and responsible guardians all the rest is secondary.
The Will: Some believe the will to be the most important document. This is especially true of single people at the older or younger end of the spectrum, who feel they don’t have enough assets to require a trust.
Powers of Attorney: Very few people feel this document by itself is the “most important”, but most people understand that as the document that confers fiduciary powers on your chosen agents, the Power of Attorney has an importance of its own.
These components are all helpful and necessary pieces of an entire estate plan, but the most important part of your estate plan is something else entirely; something grantors and beneficiaries, rich and poor, young and old, attorneys and clients alike can all agree on—the most important part of your estate plan is creating it!
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