The most important decisions affecting a patient’s treatment and care are made in the final weeks, months and years of life. Yet so few people ever talk about or write down how they want those decisions made. One benefit of the current debates about health care is a new focus on end-of-life decision making. In fact, Medicare now reimburses doctors for having conversations about it with patients.
As a financial professional you may find clients turning to you for information, especially as they approach retirement or, more likely, when they face issues with aging parents. It is essential that you are educated on advance directive documents, in order to guide them wisely.
In broad terms, an advance directive is any document that allows a person to state “in advance” how they wish to be treated if they are unable to make those choices themselves. The most common advance directive is a living will. Contrary to what many people think, living wills do not always limit treatment or “pull the plug”; they can also be used to request every medical intervention available.
Also, if someone is conscious, capable of making decisions and able to sign permission forms, there is no need to consult the living will. Living wills only take effect when a patient is unconscious, demented or otherwise incapable of making their own decisions.
The living will should be the clearest description possible of the person’s desires. Clients often list their wishes based on various situations, as they may want different treatments when imminently dying of cancer than when in a coma from which recovery is likely.
The advantages of living wills:
- They keep people in greater control of their lives and deaths, even in cases where they are unable to speak for themselves.
- They can promote honest conversations within families.
- They can help prevent legal battles and courtroom fights.
- Survivors of a loved one’s death grieve with fewer regrets and guilt when they do not have to make treatment decisions without clear instructions from the dying person.
Common problems of living wills:
- Only a small percentage of people complete one, and when they do, over half do not give copies to anyone. A living will kept in a safe deposit box or desk drawer is inaccessible when decisions need to be made.
- The perspectives of a healthy, active person can change dramatically when they actually become ill, and too few people update their documents as they age or diminish.
- Living wills are not legally binding upon health care professionals, and uninformed family members sometimes override them. Family should be informed of the person’s desires so they can support those desires with medical providers.
- Each state has their own form, so clients who use the standard living will must complete the form from their state of primary domicile.
But just because there are a number of valid concerns about living wills doesn't mean that financial advisors should discourage their clients from creating the documents. Instead:
- Strongly encourage clients to write their desires in as clearly and specifically as possible.
- Consider giving your clients a living will form called the Five Wishes document. It is available at www.agingwithdignity.org for $5 per copy, or $1 per copy when purchased in quantities of 25. The form includes everything found in a standard living will as well as names of health care proxies; additional directives such as comfort measures a person desires in their room (music, lighting, blankets, religious items); messages to leave with loved ones and wishes for services. The Five Wishes is also the closest thing we have to a nationally recognized advance directive for health care. In 42 states, it is recognized as a stand-alone valid living will. In the other eight states (Alabama, Indiana, Kansas, New Hampshire, Oregon, Ohio, Utah, Texas), it must be attached to that state’s standard living will form to be recognized.
- Schedule a follow-up to ensure clients actually do complete a living will/Five Wishes, and that it is properly signed and notarized.
- Guide clients to distribute copies to their family members and to any person or institution involved in their care, including primary doctors, specialists, nursing home, hospice, rehab center and hospitals. Offer to keep a copy in the client’s files at your office in case a family member needs one and cannot locate it.
- Add the updating of all advance directive documents to the agenda for your annual review meeting, so your client’s wishes are kept up to date.
When you educate your clients and prompt them to complete a living will, you ease their fears that someone else will dictate their medical decisions. You keep them in greater control and take a burden off their family members. You help them have valuable discussions with those they love. The resulting peace of mind is invaluable to your clients and consequently good for your business.
Amy Florian is the CEO of Corgenius, combining neuroscience and psychology to train financial professionals in how to build strong relationships with clients through all the losses and transitions of life.