The Importance of End of Life Planning

Several months ago, at a time of relative innocence, we were only thinking about one pandemic.  Then, with the murder of George Floyd, the world erupted and a second pandemic - racism -  became much more clear.  (See my last newsletter)

Having read this article several months ago, I had planned to write a newsletter about it then, but the news of the day was much more important. Circling back, I want to reconsider the article, and how poorly prepared most of us are for end of life care.  

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Fearing COVID-19, and ventilators, older people alter their living wills
By Judith Graham - The Washington Post / Seattle Times

Respiratory therapist Neeru Kaur, right, and other medical staff assist a patient in the COVID-19 Intensive Care Unit at Harborview Medical Center on Friday, May 8, 2020, in Seattle. For some older people, a ventilator is their greatest fear. For others, there is hope it might pull them back from the brink. (Elaine Thompson / The Associated Press)

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​COVID-19 has thrust this knowledge into our collective consciousness, and has helped some people make decisions for themselves that they had not done previously. In the last month alone, I have had 2 people in my life about to undergo surgery who were unprepared for end of life decisions.  They had no healthcare power of attorney, no durable power of attorney for finances, and one of them had no advanced directive accessible to anyone who might need to see it.

I now ask: What if you got COVID-19 and had to be on a ventilator? Would you want that? Have you confided to anyone close to you about what your decision would be?  

Most of us are going to answer no.

Until approximately 5 years ago, I thought that the way my family had dealt with end of life planning was normal (I can hear my siblings laughing to think I believed anything our family did was “normal”). 

• My father had a pension from the university where he was a professor, and he was able to buy extra years so that he received close to his salary after retirement. 
• My parents had filled out a very explicit advance directive long before it was needed. 
• A healthcare and durable power of attorney was in place. 
• My parents had set up a family trust.

Most interesting of all, I remember when I was in high school, my parents would sit us down around the dining room table to discuss what each of us three kids would get when they died. (My poor brother, being 6 years younger than me, got the short end of the stick.) Eight years later we sat down and repeated this discussion when we were all more mature. It did not feel morbid or scary, it was just normal.

​I have since learned that this is unusual. What it did for me was to make the subject of end of life not scary. My husband’s story is 180 degrees from mine. 

When my husband's father died prematurely and unexpectedly, there was nothing in place to guide the family, including no life insurance. Now that is scary. Thankfully, it made him proactive as opposed to avoiding the topic altogether.

Now that we are all faced with the possibility of COVID-19  and the uncertainty of how we will fare with this disease, I would like to make some suggestions. 

Here is what everyone should have in place:

1. Healthcare Power of Attorney (also called healthcare proxy or HCPOA). This is someone who knows what your decisions are, that you trust, and that you are confident will rise to the occasion and be able to make decisions about your health when needed.  In Washington state where I live, you can get HCPOA documents online.  Once you have designated your proxy, and have had someone witness it, you are prepared.  ​

In Washington, our HCPOA does not need to be notarized, although I do recommend that you take this step.   If you are traveling to a state that requires notarization, you will already have it in place. 
         
Please note that I function as a healthcare proxy for those who do not have or do not  want a family member or friend to serve in that role. If you are interested in learning more, contact me.

1. Durable Power of Attorney (DPOA) for financial matters. This is someone who will uphold your wishes in regards to your estate, large or small, if you are no longer able to manage. Often this is not the same person as your healthcare proxy, but it can be. In Washington state, DPOA forms are also online, available to all who want them.

1. Advance Directive (also called a Health Care Directive or Living Will). This important document lets other people (family, friends, medical staff) know what you want to be done in terms of medical intervention if you are not able to speak for yourself. Do you want to be on a ventilator if needed? Does it depend on the circumstances?  Do you want CPR done?  It will ask a whole host of questions that are better to figure out before the situation arises. ​

Especially now.

There are many options online to help guide you in this. You can see a previous newsletter I wrote on End of Life Planning here, or check out these resources for more information:

           Know your Choices, Ask your Doctor
           Honoring Choices Pacific Northwest
           Choosing Wisely
           WA End of Life Coalition
           5 Wishes
           The Conversation Project
           Death over Dinner

I am happy to schedule a time with you to explain your options and help you with your decision making process.

1. POLST--Physicians Orders for Life Sustaining Treatment. This document needs to be signed by your doctor and is most appropriate for those with an illness or who are quite elderly. 

1. A Will. I would be remiss if I did not mention a will.  A will indicates what you want to happen to your possessions, especially money, real estate, and valuables once you die. Remember those discussions around the dining room table I mentioned earlier? Those discussions allowed us to hash out who got each item in my parents’ house. ​

When the time came, the three of us sat on the dining room floor with all of the small items around us, drew straws for who would go first, and then picked the thing we wanted most.  We did this in order until there was nothing left any of us wanted. We did not follow what was specified in the will exactly, but we were all happy with the outcome, and we knew that was the main aim of our parents.

For those with minor children, you must make a plan for who will raise your children if both parents die, and how the money will be dealt with. This requires a lawyer, and should have been done yesterday.

All of these documents should be easily accessible, and a copy should be provided to those you have designated. 

Remember, if you need coaching or counseling about what to do or how to make these decisions, I am here to help. 

​In the meantime, stay masked, wash your hands, maintain physical distance, be kind to each other —you know the drill.