Mercury News Logo

 

 

Opinion: Americans need to face up to end of life planning

By Helga Hayse
 

Doctors have, over the years, quietly advised patients about care options at a time of a medical emergency or terminal illness. On Jan. 1, the government announced that doctors would be reimbursed by Medicare for end-of-life counseling during a regular office visit. Four days later, the government changed its position. With lightning speed, a medical decision has once again become a political one.

This is terrible news for patients and their families who need to open the discussions about end-of-life care.

Advance care counseling is long overdue and can bring incredible peace of mind. As a culture, we'd rather do anything than talk or even think about our own death. Psychiatrists have long equated the reluctance to draw up a will or estate plan with this fear of death.

Millions of families find themselves without guidance or direction when faced with a medical emergency or unexpected death. The legal forms for a living will and health care proxy haven't been filled out. No one wanted to think about the possibility that they might be needed.

We have all kinds of ways of not thinking about our death. Denial allows us to pretend that we won't be caught in that situation. We postpone filling out forms until "We're not so busy." We're paralyzed by our foolish superstition that makes signing papers a signal to God that we're ready to die. What about optimism that we'll just die in our sleep, or during sex, or our favorite sport? Why spoil the quality of life by being negative?

However, a medical emergency or a tipping point in a chronic illness will trigger the need for a living will and a health care proxy, the documents that form the basis for advance medical planning.

The living will, a medical directive form, lets others know what medical procedures and treatments we want and the conditions under which we want them. Without this, our families will struggle with decisions they have to make that may not be what we want. The health care proxy or durable power of attorney form lets us choose someone we trust to make decisions for us if we can't make them for ourselves.

Why should any child be put into a situation of predicting a parent's wishes? What a huge responsibility for parents to shunt off on children -- one that is often complicated by the possibility of friction with other siblings. Why force people you love to read your mind and make heart-rending decisions in a time of crisis? Isn't it better for both generations to talk about what they want in case they can't speak for themselves at the time -- and to put it in writing?

For example, in the Terri Schiavo case, determining what a loved one would want was neither a simple nor clear decision.

The young woman was left in a persistent vegetative state after having a cardiac arrest. Unconscious and sustained by artificial hydration and nutrition through a feeding tube, Terri was unable to speak for herself. Because she had no official medical directive, her husband, who argued that she would not have wanted to be kept alive in this fashion, was locked into a 15-year battle with her parents, who refused to allow the withdrawal of the life-sustaining technologies.

The culture of silence around financial and estate planning, medical directives, powers of attorney, lifestyle preferences and end-of-life care results in countless unnecessary financial, legal, and social complications and pain for millions of people. That's too bad; advance care planning of all kinds is a smart and loving thing to do for our families. 

HELGA HAYSE is the author of "Money, Love & Legacy: Conversations that Matter Between Generations" She wrote this article for this newspaper.

  • Money

    Talking about money can be a touchy subject for families. But it’s never about the money itself. It’s about how money shapes thinking about other things like relationships, power, rules, love, fairness, and a host of other expectations and attitudes. 

    Money Love & Legacy gets to the heart of these concepts and helps you navigate through these mindsets to get conversations going with love and respect.

  • Entitlement

    Entitlement is a one-way mindset that focuses on what we are owed instead of acknowledging that we have obligations in a relationship. Children raised with a sense of entitlement believe the world revolves them and their needs. 

    Money Love & Legacy helps parents understand that an inheritance reflects the quality of a relationship. It is not a legal obligation in the United States. Knowing that helps parents see with more clarity how they want to handle the distribution of their estate. 

  • Inheritance

    Inheritance often serves as a final report card for siblings. Childhood hurts can be revived and sibling relationships destroyed when heirs are faced with unequal portions of a parent’s estate. 

    Money Love & Legacy explores these difficult decisions faced by parents. The book shows you how to analyze and honor your deepest feelings about your inheritance plans.

     
  • Forgiveness

    Forgiveness is intentional. It’s a solo act and it is always possible. The end result of forgiveness may not be reconciliation which often is not achievable. However, deciding to forgive on your own can help ease pain through acceptance of the past. 

    Money Love & Legacy explores this concept in depth through the author’s own story. It provides guidelines for understanding your wound and provides the questions you need for healing it. 

  • Legacy

    We create legacy by how we live, not how we die. Our legacy is shaped by the values we hold, and how those values are reflected in the life we live. Most of all, it is about how we want to be remembered. 

    Money Love & Legacy shares stories of people who created their legacy by their connections to family and community. It will show you how to transmit your values through the decisions you make at the end of life. 

  • 1
  • 2
  • 3
  • 4
  • 5

Buy Money Love and Legacy

Conversations between parents and children about money