Acting as the health care proxy for a loved one who has been in the ICU for 5 days is stressful. No news here. But a new study finds that a surrogate’s confidence in their decisions can actually be increased and their stress decreased — if the patient and the surrogate had talked about treatment preferences in advance. This was true even if patients hadn’t written down their health care wishes.
So, you think you are “done” with your clients’ advance care planning when clients sign their advance directives? Nope.
The next step in proactive planning is to counsel clients to talk with their named health care agent about their wishes or goals. This is consistent with your role as a trusted advisor, not just a drafter of documents.
When talking together, loved ones can get a sense of the client’s preferences about what’s important to them. Maybe it’s certain qualities of life, or length of life, or thinking about potential tradeoffs between them. Yes, it’s true that all possible medical scenarios can’t be discussed in advance, but that isn’t the goal. (This is also why the living will is usually best used as guidance to the health care agent.)
Perhaps the scenario featured in this study could even be a catalyst for a discussion by clients who want to dig a bit deeper: Your client is in the ICU for 5 days on a ventilator. What’s important to them if they’re in the ICU because: they have a terminal condition? Are in an irreversible coma? Have had a stroke and may remain severely physically impaired? Or severely mentally impaired? The answers might be different.
Is this topic really necessary for you to advise your clients about? Consider this: on average, ¼ of your elderly clients will die in an ICU. Even more will die in situations requiring their health care agent to make decisions. What do you want to do to help your clients’ spouses, adult children, or other surrogates feel more confident that their decisions will be in your clients’ best interest?
PS Thanksgiving is a great time for clients to talk with their families about healthcare wishes. Folks are relaxed and not in the midst of a medical crisis. This 2-minute video is a good inspiration for clients. Click here if you’d like a draft article for your client newsletter or e-blast encouraging clients to “have the talk” over Thanksgiving.
Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), the largest advance directives registry in the U.S., which ensures that the emergency information and healthcare directives of its 200,000 enrollees are immediately available 24/7/365. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. A member of the International Society of Advance Care Planning, she is active in health policy and health education related to advance care
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