Chapter – 10
PREPARING FOR DEATH
Death is inevitable. No one is exempt.
– The Nine Contemplation of Atisha, 11th Century.
A Turkish proverb says “Death is a black camel that kneels at everyman’s gate.” There is only one certainty in life, and that is sooner or later it will end. No matter what of kind of genes we have inherited, what kind of food we eat, how much exercise we do, we will not live forever. Intellectually we all know that death is a fact of life. But most of us tend to avoid thinking about it, let along planning for it.
According to Jane Brody, the well-known columnist of The New York Times and the author of Jane Brody’s Guide to the Great Beyond, “Too many people wait until it is too late to determine how they wish to spend their final days”. Too many people have neither discussed nor recorded their end-of-life wishes with people most likely to have a say in the matter…. Too many people spend their dying days suffering needless with intractable pain or plagued by futile medical interventions…… Too many people assume incorrectly that having written a living will, they are protected from unwanted interventions when death is near.” Nobody can be fully prepared for death. But by taking certain steps, one can minimize the pain, suffering, mental agony, confusion and uncertainty of the death process. The time for planning is now, no matter whatever is your age.
Some of the measures you can take care:
- To have a properly executed will and testament so that your heirs will know, how you wanted your assets distributed – that is called “estate planning.”
- Most important of all, to assign guardians for your underage children, along with the means to support them, should they become orphans by the death of both parents. That is called “the designation of guardians.”
- To officially designate someone you trust to speak for you when you cannot speak for yourself. It is called – “Healthcare Proxy.”
- To let your family and physicians know your end-of-life care wishes. It is called – “Advance directive.”
Estate Planning
Estate planning is the process of anticipating and arranging for the disposal of an estate (-all that a person owns) during one’s lifetime. Guardians are also designated for minor children.
Estate planning involves the will, trusts, beneficiary designation, power of appointment, ownership, gift, and power of attorney, specially durable power of attorney and the durable medical power of attorney. Estate planning documents are legally binding documents, hence should be drafted and executed preferably with the help of qualified attorney and tax accountant.
(A) Will and Testament
A Will or Testament is a declaration by which a person, the testator, names one or more persons to manage his or her estate and provides for the distribution of his/her property at death.
Historically “will” was limited to real property (land, houses etc.) while “testament” applies only to disposition of personal property hence the name “Last Will and Testament.” There is no legal requirement that a “will” be drawn by a lawyer. Any person over the age of majority and of sound mind can draft his own will with or without aid of a lawyer. However, it is better to consult one. A will can be modified or revoked anytime by the person making the will (testator).
After the testator has died, a probate court determines the validity of the will or wills.
(B)Durable Power of Attorney (DOPA)
It is a legal document that allows someone to make legal and financial decisions on your behalf. However, the agent with DOPA cannot make healthcare decision for you. For that you need a health-care proxy. Appoint a back up agent and update the agents as your circumstance changes.
Advance Healthcare Planning
Advance health care planning can avoid the court entanglement in life-sustaining medical decision making. It can avoid some of the decisional crisis which doctors and family members can face when death is near. Advance healthcare planning includes two documents: (a) living will, (b) a healthcare proxy.
(A) Living will or Advance healthcare directive
A living will is also known as an advance healthcare directive or personal directive, or advance decision. A living will usually provides specific directives about the course of treatment that is to be followed by healthcare providers and other caregivers including the hospital. A living will can be very specific or very general. An example of a general living will be: “If I suffer an incurable, irreversible illness, disease or condition and my doctors decide that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.
More specific living will may include much more detail information regarding an individual’s desire for such services as pain relief, use of antibiotics, hydration, feeding, and the use of respirator (breathing machine) or Cardio Pulmonary Resuscitation (CPR). However, as living wills began to better recognized, key deficits were soon discovered. Most living wills tended to be limited in scope, and often failed to fully address presenting problems and needs. Further, many individuals wrote out wishes in ways that might conflict with quality of newer medical care. Ultimately it was determined by medical and legal experts that a living will alone might be insufficient to address many critical end-of-life healthcare decisions. This led to the development of “Second generation” of healthcare proxy or advance directives.
Healthcare Proxy or Durable Power of Attorney for Health Care Decisions or Durable Medical Power of Attorney.
Healthcare proxy, or Durable Medical Power of Attorney, allows an individual to appoint someone to make healthcare decisions in their behalf if they should ever be rendered incapable of making their wishes known. The appointed health care proxy has, in essence, the same rights to request or refuse treatment that the individual would have if still capable of making.
The main benefit of a health care proxy is, the appointed individual can make real-time decisions in actual circumstances, as opposed to advanced decisions framed in hypothetical situations, as recorded in a living will.
Eventually, however, deficiencies in “second-generation” advance directives were also noted. Studies found that most of what appointed proxies are told is too vague for meaningful interpretation. The continuing problem led to the development of what might be called “third generation” advance directive.
Perhaps the best known third generation of advance directive is the Five Wishes directive. This document was developed in collaboration with multiple experts with funding from the Robert Wood Johnson foundation. The most recent Third- Generation advance directive is the Life care Advance Directive. It has greater patient proxy decision-making accuracy and superior to existing similar documents. The primary criticism has been that it is very lengthy and tedious to complete.
Advance directive documents are available online. To make the best choice, individuals should consider reviewing several documents style to ensure that they complete the document that meets their personal needs. If you are in doubt or do not understand certain medical terminology, talk to your doctor and get it clarified.
Without a legally binding advance directive, families can face the gruesome decision to end or continue with life-support. Many times there is disagreement among family members, doctors and the hospital. The matter may end up in court, incurring great expense and untold anguish. But even with a living will, conflict can arise between families and treating physicians.
To minimize such conflicts, create a well-thought-out and fully spelled out living will. Waiting to complete a living will until you are hospitalized with a life threatening problem could be too late. The best time is now.
Once your living will is executed, give a copy to your emergency contact (spouse partner or adult child), your personal physician (discuss with him also), and to your healthcare proxy. Keep the original with your personal records along with your last will and testament and other estate papers.
Finally keep in mind that as your life circumstances changes you may want to revise your living will and other appropriate documents. You can do it at anytime as long as you are of sound mind. Be sure to send the changes to everyone who has the copy of the original.
As Jane Brody wrote – “You can – you must, for your own sake and the sake of those you love – help to change the culture of denial and avoidance to one of acceptance and preparation. You and your heirs will be glad you did.”