Advance Directives in the Real World
Many people wait too long to create advance health directives
and designate a health care surrogate, and the results can be tragic. A recent article, by a physician who is also a financial planner, illustrates a not-uncommon situation that nobody wants to find themselves in.
The story begins with a woman suddenly becoming acutely ill and
uncommunicative. She’s rushed to the emergency room by ambulance, while her
partner scrambles to get to the hospital. The patient’s condition quickly worsens.
By the time her partner arrives, it has been determined that the patient will need to
be placed on a ventilator, or she’ll die. But her death appears to be inevitable, so
this will only prolong her time in a hospital bed.
Who is going to make that decision?
The partner had been designated as the patient’s health care surrogate, but in this
case, couldn’t remember how to find the documentation. The woman, unconscious
in the hospital, had been adamant in her conversations about advance
directives—which serve as a record of someone’s health preferences—that if she
had a serious health event that was going to kill her, she wanted to be kept
comfortable and have as peaceful a death as possible. Her partner had participated
in these meetings, had been named the health care surrogate, and had been
involved in drawing up the advance directive.
Unable to find the documentation, the hospital would have had little choice but to
put the patient on a ventilator. In this story, over the next few hours the condition
worsened, and the doctors determined that the patient had contracted pneumonia
that had spread to her bloodstream—causing her kidney to fail. She could be kept
alive, temporarily, with dialysis, but even then her prognosis was grim.
Plan and document.
Fortunately, in this story, the financial planner was able to fax over a copy of the
patient’s advance directive and the documentation establishing the partner as the
health care surrogate. Even then, it was a difficult choice for the partner to follow
the directives and tell the hospital not to use the ventilator or dialysis treatment. A
phone conversation with the financial planner helped give the partner the peace of
mind to make the decision that the patient would have wanted, and the patient died
peacefully with her family by her side.
Documenting a desired quality of life in the final days is not a medical
conversation, so a doctor or health care professional is not required. People can
have this conversation with their financial planner, who will contact an attorney to
draw up the paperwork, and who can provide the final documents while allowing
the financial planner to keep a copy on file. The challenge is for people be willing
to have this difficult discussion while they’re well. The incentive is that a
thoughtful, well-documented advance directive conversation can alleviate a lot of
the stress of painful decisions during a serious illness.