End-of-life care: Decisions should be made now

It would stand to reason that doctors would be exceptionally good at making end-of-life medical care decisions — after all, they know more about suffering and chances of recovery than most.

So what measures would doctors choose for their own end-of-life care? A new survey by a professor at USC offers some surprising results.

Doctors, it turns out, are much less inclined to favor invasive methods for prolonging life than their patients seem to be. Ninety percent of the physicians surveyed said they would not want CPR; more than 85 percent said they would not want a ventilator; and more than 75 percent said they would not want a feeding tube. The only form of end-of-life care a majority of the doctors said they would want was pain medicine, which they were overwhelmingly in favor of. (The entire survey results can be found here.)

These are the kinds of questions that require careful thought and preparation long before the answer is required. They require a sympathetic soul who will feel obligated to carry out the patient’s wishes, even if it is personally painful to them. It’s difficult for a son to say goodbye to his mother when there is a chance to prolong her life — which makes it all the more important to make sure the mother’s wishes are clear.

There are many options that you can encourage your clients to consider in this area, all of which fall under the rubric of health care directives. The simplest is a living will, which dictates what type of medical care your clients would receive if they are unable to speak on their own behalf. They can choose in advance the types of medical interventions they’ll allow, like CPR or a respirator or an intravenous feeding tube.

A living will can be very useful for anyone, but especially for someone who doesn’t have a close relative he or she trusts to make critical decisions. If a client is widowed or divorced, without children or estranged from them, a living will becomes a must. Other options let those closest to the patient make decisions, but the living will is the best way for patients to make their own decisions.

To assign decision-making powers to another person requires a power of attorney. These come in a variety of flavors and are appropriate for different people in different situations. Some of the ones to bring to your clients’ attention:

• A durable power of attorney gives a person power to make all sorts of medical decisions on the patient’s behalf. The “durable” part refers to the fact that it continues even after the patient is incapacitated; other powers of attorney end upon incapacitation (or death).
• A general power of attorney grants to the person the right to make decisions on the patient’s behalf, but it doesn’t extend past incapacitation. But it is very useful for a person who is seriously ill or hospitalized and who may not have the energy or will to carry out important decisions. With this or other more limited powers of attorney, an incompetent patient would need a court to appoint a conservator or guardian in order to have decisions continue to be made.
• Another option is a springing power of attorney. This is the mirror image of a general power of attorney in that it doesn’t come into effect unless and until the patient is incapacitated. A client who is in good physical and mental health and feels capable of keeping control of all decision making would be a good candidate for this.

All these powers of attorney are constrained by the patient’s own wishes. You can assure your clients that even with one of these documents in place, their own wishes will always take precedence and can never be overridden.