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Planning for the End

Posted by on in Current Medical Issues

As spring has arrived, I have been immersed in something that involves the end of things rather than the beginning. Recently, I started a new service helping people plan for what they want at the end of their lives (i.e. helping them figure out what they want in their advance directive), while also serving as the healthcare power of attorney for those who do not have or do not want a family member to do so.

Writing this newsletter was spurred by an article I read recently by an attorney—no longer practicing—who holds the position that lawyers have no business in the field of advance care planning.

Lawyers have no business in the field of advance care planning

by Phyllis Coletta

The author of the article, Phyllis Coletta, says:

Here’s what happens when a lawyer gets involved in advance care planning: They tell you to appoint a health care agent, but don’t stress that you must talk to that person and all other loved ones about your values and range of decisions.  


My ER doc friends tell me there is no document that comes close to the help of a well-informed family at the bedside.

I often tell people that I thought my family was the norm in terms of advance care planning. (Why I thought this was the case is a mystery to me!) My parents had a very thorough advance directive, which we all had copies of, and we all knew who the agents in charge were. When crises occurred, we could read the document to figure out what each parent wanted for their care. Further, my siblings and I are very close to each other and would talk frequently to ensure their needs were being met. Also, my parents had arranged for themselves financially, which reduced the burden on us as their children.

When I began researching this kind of work, I was surprised by what I found. I was astonished that potential clients did not realize that I needed to spend quite a few hours with them to get to know them, and what they would like to happen if they are unable to speak for themselves. In fact, I tell them that I am channeling them, so it is important to know who I am channeling! Isn’t that what we all want—someone who will carry out our wishes as close to what we would do for ourselves as possible?

What have I found instead?

  • An elderly couple who have designated their 3 children to have equal status for decision making, and who expect them to vote if they disagree and have the decision made by majority rule. Red flags right and left. Don’t do this, anyone.

  • A family who rewrote the document delineating desire or not for CPR so it would be construed by the hospital as: resuscitate me if I am dead (Cardiac arrest) but don’t do anything if I am alive and failing, toward the point where I need an intervention.

Both of these situations are due to lack of spending the time in a nonconfrontational way to explain, explore, and figure it out with those who you love or have entrusted with your care.

I want to leave you with some really great resources for figuring out your or your family’s end of life decisions.

5 wishes

death over dinner

the conversation project

This is a conversation that does not need to be painful, sad, or morbid. It can create connection, and avoid a lot of pain in the end!

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