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Healthcare Directives in Estate Planning: Physician’s Wary of Measures to Extend Life

Posted Friday, June 6, 2014 by Michael A. Larson

As an estate planning attorney, healthcare directives and POLSTs are usual and standard estate planning documents and topics of discussion. Recently, when discussing these and other estate planning documents, I surprisingly discovered that a large majority of physicians believe invoking life sustaining measures mostly create more misery. Those studied physicians by a large majority elect instead not to have many of procedures to prolong life if they were personally in critical life-threatening condition.

A health care directive is also known as a living will. The health care directive is preferably coordinated with a durable power of healthcare that can direct the attorney-in-fact and healthcare providers not to provide life-sustaining support if the individual is in a terminal condition and provides directions to prolong life under different scenarios. There is also the election whether to provide nutrition and hydration while facing end of life decisions.

A POLST is an acronym for physician orders for life-sustaining treatment. The POLST provides a detailed array of directives to treating physicians such as using medication to relieve pain, whether to provide antibiotics, artificially provided nutrition and directs who is authorized to participate in these decisions.

These are personal decisions and we maintain neutrality regarding what a client decides about these critical medical situations. In that context I do help inform clients make these decisions based on my long experience of listening to diverse philosophies and commentary from clients including doctors, religious advisors, nurses and other healthcare professionals and from a wide variety of people I talk to plus from attending professional education events about these topics. In my 30 years of practicing law I have heard nothing that would amount to a general consensus on these issues.

In this recent meeting I was surprised that practicing physicians are loath to allow CPR, ventilation, dialysis, invasive testing, feeding tubes, antibiotics, IV hydration and pain medication when dying and facing life-threatening situations. The podcast by “Radiolab” discussed this dilemma about living by any way possible and dying in peace. See http://www.radiolab.org/story/262588-bitter-end/ for this podcast called “The Bitter End”.

The doctors who participated in the study by 80 to 90% margins state the end of life procedures are not statistically effective in leading to a longer life and many times these life preserving measures only create end of life misery. 

Next time these important personal issues come up, I will always respect a client’s personal views on these issues. However, in the proper circumstances, I will recommend this broadcast as a tool to become informed on this topic, death, something we all will sometime encounter, but none of us want to plan. But on the other hand, good planning for these big life events can have its rewards. For more information, please contact Michael Larson at 206-340-1131.

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