End-of-Life Choice, Palliative Care and Counseling

healthcare proxy

Struggling: End-of-Life Conversations

by Patricia Patton
Huffington Post
November 17, 2012

It is the end of life.

My sister lies in her hospital bed, and I am being challenged to set her free. But what I really feel like doing is SCREAMING at the top of my lungs. The doctors have finally stated, “We can make her comfortable.” That means the family must now shift gears and face our reality.

I had been managing my sister’s emotional care from across the country. In truth, her husband had been her primary caregiver and I was his wing wo/man. I had been criss-crossing the country, trying to help her experience some joy by staying close to her and by helping her heal old wounds with her adult children. The downward spiral had begun in earnest at least 18 months before. However, consistent with our black southern tradition, my family had not taken even one of the AARP recommendations for those preparing for death. Why? Because of religious beliefs and my sister’s children and her husband were in denial. Also they really didn’t know what to do.

AARP research has found that 46 percent of family caregivers perform medical/nursing tasks for their patients who are suffering with multiple chronic physical conditions. My sister had been suffering from kidney failure and breast cancer among other things. So her husband was indeed a part of this 46 percent statistic. He was also one of the three out of four (78 percent) caregivers who managed medication, including administering intravenous fluids and injections. He performed these tasks to avoid institutionalizing her because their financial resources would not have allowed for assisted care or live-in help.

So, as I was saying, there we are in the hospital and clearly we are approaching the end of her life. The sister I know is gone, even though her body is lying in the hospital bed. Technically she is still here, thanks to a ventilator — but I don’t think this could be called living. More

The Elder Law Minute: Do I Have the Right to Die?

by Ron Fatoullah
The Queens Courier
November 10, 2012

On October 5, 2012, a New York Appeals Court ruled in support of SungEun Grace Lee (Grace), a 28 year old banker who wanted to be taken off life support and allowed to die. Grace, who has terminal brain cancer, is paralyzed from the neck down and is being kept alive by artificial means. Her family disagreed with her decision and petitioned for guardianship to make health care decisions on her behalf. They argued that she was incapacitated due to her medicated state. The issue of an individual’s right to die is complex, to say the least. While the law does not permit assisted suicide, a patient always has the right to refuse medical treatment. This may include the refusal of life-sustaining treatment which could lead to death. Proper planning and possessing the necessary legal documents can help to enforce our right to refuse medical treatment. In addition, having the proper legal documents can help avoid or minimize conflict between loved ones when the difficult decision pertaining to “pulling the plug” arises.

Health care decisions, including decisions regarding life-sustaining treatments, are made by the individual patient. The issue presented in the case of Grace (and the famous Terri Schiavo right-to-die case), is one in which the capacity of the patient to make such decisions is questionable. In New York State, once a person is deemed incapable of making health care decisions, these decisions can be made by an appointed agent under a duly executed Health Care Proxy.

Planning for health care decision-making, in the event of incapacity, is not an easy process. It is often the most difficult process for our clients who are engaged in elder law planning. The issue requires individuals to delve into grim and morbid topics of illness and whether or not to “pull the plug” and in which scenarios to do so. Understandably, individuals often avoid signing a Health Care Proxy or sign a Health Care Proxy without having an informed discussion with their appointed agent. Having a Health Care Proxy allows one to choose the person he/she trusts to speak on his/her behalf and ensure that one’s rights and wishes are upheld. The discussion about one’s wishes regarding health care decisions is as important as naming the person to make these decisions. Again, the discussion ensures that decisions are made based on the individual’s expressed wishes. It avoids or minimizes conflict that can lead to litigation as in the cases of Grace and Schiavo. It also lessens any guilt on the part of the agent who may have to make the decision about whether or not to withhold or withdraw life-sustaining treatment. Most importantly, the law requires clear and convincing evidence of an individual’s wishes before an agent can have the authority to withdraw or refuse life sustaining treatment. Therefore, having a serious and in-depth discussion with the appointed agent and any successor agents is a vital part of the process of executing a Health Care Proxy. More