The COVID-19 pandemic brought renewed focus to health care decision-making. Over the past two years, countless families and individuals had to make crucial, urgent decisions on medical care for their loved ones. The consequences of these decisions are enormous, and too many people found themselves unprepared, not knowing what kinds of interventions were wanted or unwanted, how to balance aggressive treatments with comfort and quality of life, and when to stop life support.
Granted, your clients likely all have a living will and a power of attorney for health care, because most estate planning attorneys include those as a standard part of their service when creating a last will and testament. Yet how many of your clients have been guided to give serious thought to their health care wishes, and how many have conveyed that information to the powers of attorney they appointed to make decisions for them? In honor of National Healthcare Decisions Day on April 16, can you help them do more?
These are steps you can follow:
- Pose the following scenario: “If you were in an accident today and ended up unconscious in the emergency room, someone would make your treatment decisions for you. Would you want that to be the overworked ER doctor who never met you? Would you want your family arguing about your care and actually getting the treatment that your most vocal and stubborn family member wants you to get? Or do you want to be in control as much as possible, making your decisions known even when you can’t speak for yourself and choosing the person to represent your interests? I know you have a basic power of attorney for health care and the state’s standard living will, but I think it serves you and your family best if we revisit those documents to ensure they protect you and keep you in control in the ways you want.”
- Then address the living will itself. The No. 1 question for your clients: “What is quality of life to you?” Just as with finances and legacy, this digs deeply into what they want and why, uncovering their ultimate goals and vision for themselves: “What do you need to be able to do, feel, understand or participate in, that makes it worth it to use artificial means to prolong your body’s life, and at what point, if any, is that no longer worth it? Some people want every known intervention to keep their body alive as long as possible. Most people have some kind of limit, whether physical, cognitive, psychological or otherwise. What, if anything, is yours?”
An example to get them thinking: One woman decided that if she’s at the point where 50% of the time she no longer recognizes her family, she wants no more artificial interventions and instead wants to live the best, most comfortable life she can until her body comes to a natural death. This decision, conveyed to her family and POA, frees them from arguing and guilt over whether to tell doctors to insert a feeding tube when dementia takes away her ability to swallow or she simply stops eating. She doesn’t want to extend her body’s life at that quality and she accepts the process of natural death.
Another possibility: One cancer patient said that if rounds of chemo had done minimal good but had debilitating side effects on quality of life, he would not want another round of chemo unless there is at least a 75% chance it would increase the length of his life by three times as long as the length of the chemo itself and that his remaining time would be at a quality of life that would allow him to get out of the house, walk, go to social engagements and visit with his grandkids.
Get your clients thinking about what they would want in these and other scenarios, so they can provide clear guidance to their family and doctors. Along with your prompting, a great tool to help them think through these things is The Conversation Project. The site has videos, questions and resources, including a starter kit for family discussions about health care decisions.
- Once clients refine and clarify what treatment they want and why they want it (their quality-of-life wishes), go on to confirming that the power of attorney for health care is a person they trust to carry out those specific wishes. Also ensure they have at least one alternate, in case that person can’t or doesn’t want to serve at the time. Many couples appoint a spouse, for instance, but what if they’re in an accident together and can’t serve? Then who?
Emphasize the importance of trusting those people to implement your wishes as directed. If your client wants every treatment available, would their POA willingly do so even if the POA personally believed the treatments were futile? Conversely, if your client wanted to refuse or disconnect treatments, would their POA do so even if the POA personally believed trying every intervention possible is the better choice? Because of the emotions involved in these actions, many people decide to appoint nonfamily members who can more objectively carry out their wishes. Clients must be able to trust their appointees.
Then the crucial step for your client is to inform their POA and alternates, giving them a copy of their detailed living will, perhaps with an additional Word document attached that explains the reasoning behind those decisions and the quality of life they wish to maintain. Too many POAs know they are appointed but do not understand the wishes well enough to interpret any situation in light of the “why” behind the wishes.
Overall, do more than simply provide forms. Encourage reflection, thought and wise decision-making. Then do what you can to ensure clients convey those decisions to their families, caregivers and medical professionals, so everyone is on the same page. You will prevent untold nightmares for everyone involved.
Remember, too, that their decisions have wide-ranging implications for their finances. Your knowledge of their wishes may prompt different products like long-term care or disability insurance, or a restructuring of the portfolio to better ensure their wishes can be funded. Have these discussions. They serve you, your clients and their families.
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.