Recently, I asked a family member, in his late 70s, walking around with very advanced heart disease, sporting his second bypass surgery scar, fresh from his second hospitalization from pretty serious cellulitis in his legs, still on antibiotics from his third urinary tract infection “Have you and your wife (second) made advanced directives or is she AT LEAST your medical Power of Attorney?” His answer…
“We’ve been meaning to get a lawyer and do that power of attorney thing for a while, just don’t have the extra cash around right now” and “as for the Advanced Directive….she knows where I want to be buried.”
“Okay”, I said, “We have to talk.”
Like the thousands of people I work with every year, this family member doesn’t really have the right information about what end of life planning is AND as I have written before (quoting my oft quoted life partner and management coach spouse) FAIL TO PLAN, PLAN TO FAIL. And I see it all the time. I go into the hospital room and find an elderly man who is minimally responsive, declining, weak. His sweet wife is sitting by his side holding his hand. She is overwhelmed with the news that she needs to decide whether to take him home and care for him on hospice or to continue to try medications and treatments that MAY have a CHANCE of making him live longer. But no one can tell her they will make him better. On top of that, he is not eating or drinking and she is not sure about a feeding tube. He is barely breathing and she can’t decide is she should agree to have him placed on a breathing machine or not. She remembers they talked about it a little when an old friend got sick but it seems like that was different, the old friend had suffered from a stroke, not a hip fracture like her husband. Her husband was fine just 3 days ago. He was working in the garden 3 days ago, how can he be dying now? Of course they never talked about this…..
- You do not need an attorney for a Medical Power of Attorney (MPOA). Every state has its own Medical Power of Attorney form and you can find yours on this site by clicking this link: AARP Link to State Forms . Although the document is called a Power of Attorney, it does not require and Attorney. The word “attorney” means “a person appointed to act for another in business or legal matters” so Power of Attorney is a document that gives someone the power to act on behalf of another. It does not mean in any way that you need an attorney. What makes it official is that you must have it correctly witnessed OR the signatures need to be notarized. Witnesses (there should be two) should be unrelated to the person making the document or the person being designated as the power of attorney. A notary can be found at there bank where you have an account, some public libraries, senior citizen centers, courthouses, police departments (some). Call around, if they are not free, many places charge as low as $10. DO NOT PAY A LAWYER TO DO A MEDICAL POWER OF ATTORNEY. He will charge a mint and it is not necessary.
- A MEDICAL POWER OF ATTORNEY is only activated when you are unable (either not able to or not competent to) speak for yourself. Competency is determined by your health care providers, not your family members. If you have dementia and you are confused, your physicians will document this in your medical records. This is how your competency to speak for yourself is determined. Non-professionals cannot decided that you aren’t fit to make your own medical decisions. Do not worry about someone else deciding about your medical treatment when you are totally able and willing to do it yourself.
- A MEDICAL power of attorney gives NO ONE access to your money, your assets, your property or decisions about any of that. I hear stories about this ALL THE TIME. And every time, these stories are the result of incorrect retellings. No MEDICAL POWER of ATTORNEY has EVER, EVER, EVER, allowed someone’s daughter’s evil husband to steal all of their savings. OKAY? IT CANNOT HAPPEN. PERIOD. It only allows them to decide what should or should not be done for you if you cannot indicate what you do or don t want for yourself.
- A Medical Power of Attorney DOES NOT NORMALLY EXPIRE. The only time a medical power of attorney could expire is if you write an expiration date on it OR if you make a new one with a newer date. That makes the older one with the older date immediately expire.
- A Medical Power of Attorney is USUALLY good in another state (if you have it with you.) Most states respect the MPOA from another state. HOWEVER, if you are going to permanently relocate to another state, it is best to make a new MPOA for the state in which you are going to reside.
- EVERY PERSON over 18 should designate someone who they want to speak for them if they are unable to speak for themself in matters of healthcare. EVERYONE.
WHY WOULD YOU ASK SOMEONE TO SPEAK ON YOUR BEHALF AND NOT TELL THEM WHAT YOU WANT THEM TO SAY?
Well, that is what the Advanced Directive does. The Advanced Directive can also be called a Living Will or Directive to Physicians and Surrogates. The Advanced Directive takes what you think people understand about your personal preferences and puts them on paper so that no one has to guess. Why is this important? Let me tell you a story…..(you had to know this was coming):
A family is gathered around the bed of a middle-aged man whose kidneys are failing and who is unresponsive. His heart is beating, he is on a ventilator (breathing machine with a tube in his airway to his lungs) but he is not breathing at all on his own. He has a tube in his nose going down to his stomach providing liquid nutrition. He has been like this for 5 days. In the last two days, his cardiologist has told his wife that his heart is doing better, his kidney doctor has told her that he is tolerating dialysis “well” and his brain doctor (neurologist) has told her that he may never wake up. The internal medicine doctor says there is nothing else that can be done. His wife does not know what to do. He has had kidney disease for 5 years, he has been getting sicker and sicker. They talked and talked all those years, they knew he was declining in the last year but he never expressly said that he wanted this or did not want that. They never talked about this with their family members either, they did not want to UPSET anyone.
WELL THEY ARE ALL UPSET NOW because they don’t know what to do and cannot agree on what he would want. His wife is pretty sure that he would just like to be made comfortable and be let go but she is afraid her children will never forgive her. His adult children are ABSOLUTELY SURE that he was ALWAYS a fighter and would keep fighting now and forever if he was able to express his choice. His sisters think he looks so uncomfortable with the tubes in his nose and airway and would like to just see those removed and nature allowed to take its course but his mother thinks it is cruel to watch him lay there and starve and smother.
This is where an advanced directive would have been a gift to everyone including the patient. It could have been very simple:
- If I am suffering from an incurable condition and my quality of life cannot be restored with treatment:
- I do not wish to be intubated and placed on mechanical ventilation if I am unable to breathe adequately on my own
- I do not wish to receive artificial hydration or nutrition if I am unable to eat and drink
- I do not wish to receive CPR if heartbeat and respiration has ceased.
- I want to be made as comfortable as possible with pain medications, medications to ease anxiety and agitation
- If I am unable to indicate these wishes for myself, I have designated a medical power of attorney to make these wishes known on my behalf.
- I expect my family members and my loved ones to support my decisions as stated above.
There are a million types of Advanced Directives. The best place to get one and complete it is at your doctor’s office. In fact, discuss your decisions with your doctor, get his opinion on what you think you want and the reality of the decisions you make. He knows your health issues and what you might be facing. He knows what he can and cannot do for you and still restore your health and quality of life. Ask him how he views the difference between keeping you alive and keeping you living. Alive and living are two very different things. You can also look on the same AARP site (see the link above).
- You do not need an attorney for an Advanced Directive. They will just charge you a mint and you don’t need one.
- AN ADVANCED DIRECTIVE is only activated when you are unable (either not able to or not competent to) speak for yourself.
- AN ADVANCED DIRECTIVE DOES NOT NORMALLY EXPIRE The only time an Advanced Directive could expire is if you write an expiration date on it OR if you make a new one with a newer date. That makes the older one with the older date immediately expire.
- Advanced Directives vary greatly from state to state so if you are going to be in another state for more than just a vacation, look into what is required by that state.
- ADVANCED DIRECTIVES ARE NOT FOR EVERYONE OVER 18. IF YOU ARE RELATIVELY HEALTHY OR YOUNG, YOU MOST LIKELY SHOULD BE RESUSCITATED AND HAVE AGGRESSIVE TREATMENTS AND PROCEDURES IN AN ATTEMPT TO RESTORE YOUR HEALTH AND GIVE YOU AS MUCH QUALITY OF LIFE AS POSSIBLE. YOU PROBABLY HAVE A HIGH LIKELIHOOD OF RECOVERY IF YOU HAD PRETTY GOOD HEALTH PRIOR TO YOUR ACCIDENT OR ILLNESS. HOWEVER, IF YOU ARE OLDER, HAVE A PROGRESSIVE DISEASE THAT CANNOT BE REVERSED OR STOPPED IN ITS TRACKS AND YOUR HEALTH IS DECLINING, ITS TIME TO LAY DOWN THE GUIDELINES FOR WHAT YOU WANT IF YOU REACH A POINT WHERE YOU CANT EXPRESS YOUR OWN CHOICES.
So, what was the outcome, well, I talked to that relative’s second wife and he was right. She does know where he wants to be buried. But that is it, she has no clue what he wants if he has a severe stroke tomorrow that incapacitates him but doesn’t take his life. Man, are they going to have a conversation tonight.