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It’s Time to Talk Treatment: Advance Directives Come From Crucial Conversations

December 19, 2022Filed Under: Estate Planning

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The thought of our own death is one of the most challenging things we will ever face. Yet it is very important to think carefully about the medical treatment we would want for that challenging time. Medical technology can now keep us alive long after we have ceased to enjoy a meaningful quality of life.

A series of legal rulings around thirty years ago established the rights of patients to decide when life support should be stopped. The fear of being kept alive indefinitely by artificial means led many to create legal documents known as advance directives.  An advance directive expresses our wishes about the kind of medical treatment we would prefer. It is called “advance,” meaning ahead of time; and “directive,” meaning our directions for whether we want medical providers to keep us alive at all costs, or whether we would prefer to pass naturally when life becomes no longer meaningful. It is wise to think about this, and to create such a document, well before we are facing the end.

After thirty years, concerns have now shifted to assess whether advance directives really do serve the purpose for which they are intended. Do advance directives really ensure that we receive the treatment we would like?

The short answer is “yes but.”

Yes because it is just as important now to create a legal document by which to appoint a person to help communicate our wishes. The “but” part comes in with the issues raised below.

The answer to these issues is the same as it has always been: to establish a close relationship with one or two people – called “agents” or “proxies” – whom patients appoint to step in when patients can no longer make healthcare decisions for themselves. Patients must talk with their agents so the agents will know, in as much depth as possible, where the patient stands on end-of-life questions.

Over the years, we have learned that advance directives might not work as well as they could. Here are the concerns that have emerged:

➢        It is unrealistic to micro-manage health care in advance. There are so many variables that depend on the particular situation. Treating a complicated illness has been likened to a jigsaw puzzle, where each puzzle piece could fit multiple other pieces; the right fit for each piece must be arrived at, often by a team of various specialists who sort through the pieces and collaborate in assembling the picture. Under those circumstances, it can be difficult, if not impossible, to interpret a legal document that was intended to guide detailed medical treatment for as-yet-unknown conditions.

➢        The “check-the-boxes” approach taken by many “fill-in-the-blank” forms is too crude to be helpful in any but the most general of ways. Without additional detail, these documents don’t adequately address the nuances that almost always arise.

➢        Change is constant and humans are adaptable. It is one thing to imagine, when in good health, that life would not be worth living if, say, one became permanently bedridden. But when the patient is actually in that situation, new meaning in life could emerge. Choices made years in the past might look a lot different in the moment of truth.

➢        The prognosis can change with time. As reported in Kaiser Health News,

A New Paradigm Is Needed: Top Experts Question the Value of Advance Care Planning

if a senior contracted COVID-19 early in the pandemic, and her advance directive stated that she did not want to be placed on a ventilator, doctors tended to assume that the virus was universally fatal to such seniors. Some never got the care that could have saved their lives.

➢        The documents must be readily available, both at patients’ homes and in agents’ hands too. They must not be hidden away and forgotten about, so no one can locate them when they are needed.

The best alternative is to create an effective, current, and available legal document backed up by serious talk between the patient and the agent or proxy. A document that meets legal requirements is essential, but beyond that: conversation in advance is the crucial additional element.

That conversation should occur first between the patient and their agent or proxy, in which they discuss the quality of life issues and what matters most to the patient. The talk should avoid excessive detail for hypothetical situations that may never arise. Rather, the aim should be to provide the agents or proxies with enough information to be able to respond flexibly to unforeseen circumstances.

These conversations can be challenging. Helpful resources to assist can be found at The Conversation Project (https://theconversationproject.org) or the Centers for Disease Control and Prevention (https://www.cdc.gov/aging/pdf/acp-resources-public.pdf).

Then, if the time comes when the patient is unable to speak or make decisions, the agent will be best equipped to convey the patient’s wishes to medical providers. Knowing those wishes in advance, the agent can focus on ensuring that providers furnish as much information as possible to make the hard decisions on the facts as they presently exist.

What if you are alone and without a person whom you trust to be your agent? First, study the guidance resources provided in this article. Then call us to create a legally effective advance directive document that spells out your wishes. And the final step would be to schedule an appointment with your doctor to discuss your wishes. Give him or her a copy of your document.

Again, all must make sure that doctors and agents have copies ready for use. And everyone should also carry a wallet card to inform healthcare providers whom to call in case of an emergency. Print one here,

https://www.aha.org/system/files/2018-01/piiw-walletcard.pdf

provided by the American Hospital Association.

There are no assurances in this life, except that it will end for us all. The hope is that we will have delegated people whom we trust to step in when we need them – and that we will have talked with them about the kind of care we want to prepare for a passing that is as peaceful and merciful as it can be.

We hope you found this article helpful. If you’d like to discuss your particular situation, please don’t hesitate to reach out. Please contact our Cincinnati office by calling us at 513-771-2444 and schedule a consultation.

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How Do Advance Directives Work?

September 26, 2022Filed Under: Estate Planning

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Winnie’s nursing home room door is open, and Kevin is standing in front of it, tears running down his cheeks. The medical staff just finished inserted a feeding tube into Winnie – an act Kevin knew she didn’t want. Unfortunately, Winnie couldn’t express her wishes due to advanced dementia, and she had no legal documents that expressed her wishes not to be fed by artificial means.  Kevin had no choice but to sit back and watch his wife go through a procedure she didn’t want.

The situation with Kevin and Winnie could have been avoided through the use of proper advance directive. An advance directive is actually a collection of documents. What that includes differs depending on your needs and wishes, along with what the law allows. However, it usually means at least a Living Will, and a Power of Attorney for Healthcare.

The purpose of this set of documents is to allow you to control what happens to your health care in case you cannot speak for yourself. If certain criteria are met, your doctors must consult with your advanced directive before making decisions about your care.

Usually, what this means is that two doctors agree that an individual is terminally ill, permanently unconscious, or at the “end-stage” of a condition. Once that happens, and the individual cannot express their preferences, doctors turn to the advance directive to figure out what the individual wants.

A Living Will determines what happens to an individual making it, unlike a Last Will and Testament, which determines what happens to their money and possessions. A Living Will describes what healthcare providers can and cannot do to prolong your life and/or ease your pain when you cannot express those preferences yourself. For example, do you want to be placed on a ventilator if you cannot breathe on your own? Do you want a feeding tube and IVs set up, and if so, for how long? Do you want to be an organ or tissue donor?

A Durable Power of Attorney for Healthcare lets you choose someone to make healthcare decisions for you when you cannot. They still must follow your Living Will, but they will be able to make decisions not explicitly considered by your Living Will, in accordance with the facts of the situation. In most states, there are “default surrogate consent laws” which allow family members to make treatment decisions on your behalf, but who is chosen to make these decisions and what they choose to do may not be in accordance with your wishes, as it hopefully would be with a Durable Power of Attorney.

Other documents may be part of an advance directive by law, or they may be worth including of your own volition. These include Do Not Resuscitate orders and Physician Orders for Life-Sustaining Treatment, among others. You might also consider an advance directive in case of a mental health crisis.

This is a difficult subject to consider, and it always seems like it won’t be necessary. But nearly 70 percent of Americans don’t have plans in place for a worst-case scenario, which means for some of them, decisions may be made for them with which they would not agree if they had the capacity to choose. For that reason, it is worth thinking about implementing an advance directive even if it seems unnecessary now.

If you or a loved one would like more information about advance directives, please don’t hesitate to reach out. Please contact our Cincinnati office by calling us at 513-771-2444 with any questions.

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The Duty of a Power of Attorney

August 16, 2021Filed Under: Estate Planning

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Due to COVID-19, an impossible question especially demands a difficult answer: if you or someone you love is taken down into life-threatening illness, how far would you want extreme life-prolonging measures to be tried?

For us who are particularly vulnerable – seniors, those with compromised immune systems, those already struggling with medical conditions – this question is particularly stark. Many people are familiar with DNR orders, “do not resuscitate.” These are intended for cardiac arrest. The threats posed by the current virus, though, more often implicate breathing problems. The longer time spent on a ventilator, the greater the chances of

Many are dying alone, without their loved ones present. The New York Times recently reported on a particularly heartbreaking case.

Most people over sixty with a serious illness say they would prefer to be kept in comfort at the end, even if that care shortens life. But where to draw the line? How much time alive would you be willing to sacrifice, to decline aggressive treatment and possibly die sooner? The need to provide at least some answers is important not just for you. Clinicians and caregivers need guidance, too.

A 2017 study showed that approximately two-thirds of Americans had neglected to provide prior guidance by creating advance health-care directives like health care powers of attorney and living wills. Back then, most of us could not have imagined being in an epidemic like the one now.

Even if you or your loved ones have already done the responsible thing and created advance directives, now is the time to review those documents to make sure they reflect what you want under current conditions.

Health-care providers are ethically obligated to do everything feasible to keep us alive. If we have no advance directives in place, the system will take over – and families can end up in long-lasting anguish for having had to be the ones to make the final call. Don’t let that happen. Think through the question for yourself and talk with a person whom you trust to make that decision for you if need be. Call us for your advance health-care directives – and may you and yours not need them for a good long while. Contact us at 513-771-2444.

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Olivia K. Smith, Attorney at Law
Cornetet, Meyer, Rush & Stapleton Co., L.P.A.
123 Boggs Lane,
Cincinnati, Ohio 45246
Tel: (513) 771-2444
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Olivia K. Smith, Attorney at Law
Cornetet, Meyer, Rush & Stapleton
123 Boggs Lane
Cincinnati, OH 45246
Phone: 513-771-2444
Fax: 877-483-2119
oksmith@cmrs-law.com

Family Law Attorney Olivia K. Smith, LLC represent clients in Cincinnati, Anderson Township, Batavia, Loveland, Mason, Milford and other communities in Hamilton County, Clermont County, Butler County and Warren County.

Disclaimer: The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact me and welcome your calls, letters and electronic mail. Contacting me does not create an attorney-client relationship. Please do not send any confidential information to me until such time as an attorney-client relationship has been established.

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