End-of-life care guidelines should be updated regularly

For decades, financial experts like me have implored you to have a health care power of attorney.

Now some health care experts say you don’t need them because they don’t work.

“Decades of research demonstrate that advance care planning doesn’t work. We need a new paradigm.”

This shocking statement came from Dr. R. Sean Morrison, chair of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York. He co-authored an article written for the Journal of the American Medical Association, October 21, 2021, and was quoted in an article by Judith Graham published January 6 on Kaiser Health News.

One of the reasons for the limited value of advanced planning, according to the medical professionals interviewed by Graham, is the difficulty of trying to anticipate the almost limitless hypothetical scenarios that could arise at the end of one’s life.

“Many highly educated people think that documents prepared years in advance will protect them in the event of incapacity. They won’t,” said Dr. James Tulsky, chair of the department of psychosocial oncology and palliative care. at the Dana-Farber Cancer Institute. In Boston.

It’s powerful medicine for the “highly skilled people” in the financial planning and legal professions who have long preached that having a will and enduring powers of attorney is estate planning 101. My first response was to wonder why the medical profession has apparently sold us out. a hollow promise that patients’ wishes would be taken seriously. My second was to wonder if professionals in finance and law were assuming promises that medical professionals had never made.

Several reasons have been cited for removing durable powers of attorney and health care directives: preferences change over time and directives become obsolete; when people use standardized forms (popular with living wills), the instructions can be vague and even contradictory; documents are not available when making decisions; services to support a patient’s wishes are not available; and those with decision-making power might disagree with a patient’s stated preferences.

To me, these are not reasons to abandon healthcare guidelines, but cautionary reminders to apply them thoughtfully. From a financial planner’s perspective, health care directives and powers of attorney are not just one-time use forms. These are specific and personalized legal documents that are regularly reviewed and periodically updated. I also recommend attaching an addendum to your health care directive, such as Compassion and Choices’ Good To Go Toolkit, which takes the guesswork out of it.

The unavailability of a power of attorney during a crisis or decision point has always been a legitimate issue. In my opinion, this is one of the main reasons why they are untracked. I regularly urge clients to file these documents with local hospitals, all personal health care providers, and especially the Designated Decision-Maker.

Of most concern is the possibility of family members disagreeing with patient directives. This is especially likely if the agent named in the power of attorney is dealing with their own grief when they have to follow instructions not to keep a loved one on life support. Yet in other cases, the person who has been trusted and empowered to follow the patient’s wishes may have a compelling reason to make different choices. Again, this issue is best addressed with a detailed addendum to the documents.

My conclusion is that while these medical professionals have raised some very valid points, most can be resolved with attention to detail, follow-up, and keeping records up to date. The reality is that no legal document is an absolute guarantee that the signer’s wishes will be granted. The only real guarantee is that without the documents your wishes will not stand a chance.

Rick Kahler is president and owner of Kahler Financial of Rapid City.

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