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I recently returned from the Academy’s semi-annual Summit in Williamsburg, VA. As always, it was wonderful to reunite with the Academy members. This cohesive group has a great deal of camaraderie and energy, and I always look forward to going.
I have been attending these Summits for 15 years. What I find striking each time is just how much a relationship can develop in short spurts over a long period. I see these folks for a few days at a time, twice a year. We catch up on changes in their firms and changes in their personal lives. It’s similar to the relationship with an old friend or with out-of-town extended family. We’re not in each other’s lives on a daily basis, but it’s great to come together, catch up and reconnect.
It’s like this with your estate planning clients, too. This is why, I think, the Academy is stressing to its estate planning firms the importance of having an annual client maintenance program and helping firms establish them. (For those of you not familiar with this term, a “maintenance program” is a set of annual client services delivered to the client for a set annual fee. It often includes basic document updates and client education/appreciation programs, among other offerings.)
Yes, the obvious goals of a client maintenance program are to help clients keep their estate plans up-to-date, and to add some extra income to the bottom line in the short term. But even more fundamentally, the goal is to nurture the ongoing relationship between the attorney and the client.
A maintenance program creates the structure that allows firms to reconnect with clients at least annually, and to do so efficiently. You and your clients can see each other in the flesh once a year (or at least offer them the opportunity to see you); clients learn something useful and maybe even have fun at your annual client education or client appreciation day. Some years, you may empathize with them over a death or illness that results in the need to make a change in their estate plan; other times, your staff may answer a quick question that puts a client’s mind at ease.
These brief but periodic contacts make clients feel connected to you, and you to them.
A maintenance program helps firms achieve that holy grail of estate planning — the long-term client relationship — where the client considers you an ongoing trusted advisor. You become someone clients think to turn to in a time of new need, new financial opportunity, or family crisis.
Why? Clients feel that they can easily pick up where they left off with you last. Reaching out to your firm poses a smaller psychological barrier and takes less emotional work for them, because they don’t feel that they’re recreating the relationship from scratch.
Does it take some work to create a maintenance program? Sure. But maybe not even as much as you think. And, there are also tools and systems that can help you do it.
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 190,000 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. She is active in health policy and health education related to advance care planning and advance directives and serves as Pennsylvania liaison to the National Healthcare Decisions Day initiative. Randi is an ongoing contributor to the Academy blog.
Academy Guest Blogger
American Academy of Estate Planning Attorneys, Inc.
9444 Balboa Avenue, Suite 300
San Diego, California 92123
Phone: (858) 453-2128
www.aaepa.com
The relatively recent ability to provide very high-tech, expensive medical procedures to pets raises interesting questions for pet owners, veterinarians, and ethicists alike:
- Can we justify spending tens of thousands of dollars on a bone marrow transplant or chemotherapy for our dog or cat?
- Can we ethically own a pet if we are unwilling or unable to spend these sums on its care?
- Are we failing our pet if we decide not to “do everything” for it — and if the answer is “no” — can we avoid feeling guilty about it?
- What are our responsibilities to our pet vis à vis extending its life and/or preventing its suffering?
- Can we separate our own emotional desire for our pet to live longer from what may or may not be best for our pet?
A recent New York Times article highlights many of these ethical questions and also offers six opinions on the topic of end-of-life pet care. I found it thought-provoking and useful in two ways.
First, the article can be a useful resource for your clients if they are faced with a decision about caring for a seriously ill pet. It’s a series of short, accessible pieces.
Second, I found that shifting my own lens to think about medical care in the context of animals was a good exercise. Most of the questions above are the same ones we confront about high-tech treatments for ourselves and our loved ones. At some level, just the act of thinking about these questions in terms of animals forces us to compare and contrast these notions with our thoughts about human medical treatment. So while the answers to the questions above may – or may not – be different for our pets than for the humans in our lives, the thought process itself may actually help clients clarify their views about their personal health care decisions, as well. It did mine.
Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), the largest advance directives registry in the U.S., which ensures that the healthcare directives of its 190,000 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. She is active in health policy pertaining to advance directives and serves as a Senior Fellow at the Jefferson School of Population Health in Philadelphia. Randi is an ongoing contributor to the Academy blog.
Academy Guest Blogger
American Academy of Estate Planning Attorneys, Inc.
9444 Balboa Avenue, Suite 300
San Diego, California 92123
Phone: (858) 453-2128
www.aaepa.com
Today is exactly one week before National Healthcare Decisions Day (NHDD), April 16. The sole purpose of this grassroots initiative (now in its 5th year) is to encourage folks to do their own advance care planning.
I’ve blogged here previously about ways you can use NHDD to help both your firm and your community (see Do Well by Doing Good and Put April 16 On Your Marketing Calendar).
This year to honor NHDD, I recommend we all lead by example. In other words, let’s start closer to home — with ourselves, our families, and our staff.
- Complete an advance directive.
Think you’re the only attorney in this field who doesn’t have one? Not so; you’re in surprisingly good company! But it’s time to practice what we preach. If you don’t have your advance directive yet, just do it. We all urge clients to create these documents because they’re so important, and it’s time we take our own advice!
- Make sure your immediate family all have advance directives.
I’ve talked with two estate planning attorneys who have personally experienced the HIPAA Horror Story: when their children were hospitalized while away at college, the emergency staff refused to tell each of them anything about their child by phone without a HIPAA Release (neither “young adult” child had one). It’s a parent’s nightmare. Yet, it’s easily preventable. As an attorney, you have the document access necessary to easily protect your family. Make sure that your spouse/significant other, your grown children, and your young adult children over 18 have all signed at least a HCPOA and a HIPAA Release.
- Protect your staff.
As you know, your clients appreciate that you got them to create their advance directives by automatically including them in your planning. Sometimes, your staff needs the same kind of push — to create the vital documents that they, too, might rather avoid thinking about. You’re in a unique position to help them protect themselves. Completing their own advance directives is also a good way for your staff to understand more about your firm’s services and to have a taste of your clients’ experience. Some firms actually strongly encourage all staff members to create their estate plans (courtesy of the firm) for this reason.
- Review existing directives.
So you, your family, your staff – everyone – has an advance directive. Great! But it’s not enough to just have them. They need to be kept relevant. Your firm has its own schedule of review for your clients’ documents; why not for yours, as well? Consider reviewing documents for yourself, family, and staff on the same schedule as your firm’s client review cycle. Additionally, Charlie Sabatino, J.D., Director of the ABA’s Commission on Law and Aging, suggests these “5 D’s” as triggers for review of the advance directive: Death of a family member or friend; Divorce; a significant Decline in one’s condition; a new Diagnosis; and each new Decade.
- Talk to Loved Ones about Your Wishes
I’ve blogged about this many times before: this step is just as important as writing directives. Talk about your wishes with your family once a year. NHDD (April 16) is a good time – it gives you a reason and place to begin the discussion. Thanksgiving can be an even better time, especially if most of your extended family is together. Regardless of the day you choose, let’s make sure we all talk about our wishes, and encourage others to do the same.
Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), the largest advance directives registry in the U.S., which ensures that the healthcare directives of its 190,000 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. She is active in health policy pertaining to advance directives and serves as a Senior Fellow at the Jefferson School of Population Health in Philadelphia. Randi is an ongoing contributor to the Academy blog.
Academy Guest Blogger
American Academy of Estate Planning Attorneys, Inc.
9444 Balboa Avenue, Suite 300
San Diego, California 92123
Phone: (858) 453-2128
www.aaepa.com
From my discussions with estate planning attorneys, I know that many of you are always on the lookout for current stories to help clients understand the value of the estate planning you’re proposing.
‘The Descendants,” this year’s Oscar-winning film (best adapted screenplay) might serve just this purpose – at the very least vis-a-vis your clients’ healthcare directives.
First of all, just mentioning George Clooney to your clients might help get their attention. Second, the story conveys several powerful messages about the benefits of written advance directives and of making medical decisions in advance.
This film sets up George Clooney as a middle-aged husband whose vital, healthy wife has just been seriously injured in a tragic boat racing accident. She now lies in a coma on life support. The Clooney character, Matt King, reveals himself to us through his anguished, bedside pleadings with his wife, Elizabeth, to awaken from her coma. After three weeks of waiting, doctors tell Matt that she will never wake again.
Enter the living will. Elizabeth has completed one, and it states that she wants life support to be terminated in a medical situation like this one. (The film doesn’t mention an HCPOA.) During multiple scenes, we see King telling family and friends of her permanent condition and her medical wishes.
The film conveys, poignantly, the value that an advance directive can play for a family experiencing a devastating tragedy like this one.
The movie does this largely through what it doesn’t show us. Precisely because Elizabeth has a living will, we don’t see the added emotional difficulties the family might face if she had not completed an advance directive.
- We don’t see the doctor asking Matt King what he thinks his wife would have wanted, and King trying to decide himself, potentially agonizingly, whether to terminate her life support.
- We don’t see the compounded anger and resentments of their rebellious teenage daughter (who, beneath it all, still identifies with her mother) that might result from seeing her father put in the position of making this difficult decision.
- We don’t see the added confusion of their 10 year old daughter, who might perceive that her father has “chosen” to end her mother’s life.
- And while we do see Matt’s father-in-law blame Matt for his wife’s boating accident, we don’t see him blaming Matt for discontinuing the life support. Without the advance directive document, Elizabeth’s father, in his own grief, might not be able to resist the temptation to blame Matt for this, too.
What we do see clearly presented on screen is that advance care planning is actually a gift to one’s family in tragic situations. Indeed, when Matt King shows his wife’s father her living will and explains that she will be removed from life support, her father responds: “Elizabeth had the good sense to write this thing. She’s a strong girl. A thoughtful girl.”
P.S. “The Descendants” also has a strong plotline about other estate planning matters. See this Forbes article for a full analysis of the estate planning issues presented.
Randi J. Siegel, MBA, is the President of DocuBank, the largest advance directives registry in the U.S., which ensures that the healthcare directives of its 190,000 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. She is active in health policy pertaining to advance directives and serves as a Senior Fellow at the Jefferson School of Population Health in Philadelphia. Randi is an ongoing contributor to the Academy blog.
Academy Guest Blogger
American Academy of Estate Planning Attorneys, Inc.
9444 Balboa Avenue, Suite 300
San Diego, California 92123
Phone: (858) 453-2128
www.aaepa.com
A few weeks ago, the ABA Center for Law and Aging held a webinar: “Effective Advance Care Planning: Are Your Advance Directives Worth The Paper They Are Written On?” The purpose was to enhance attorneys’ client counseling skills on this topic and their drafting of more effective advance directives. Today I’ll share some state-of-the-art thinking from these leading advance care planning experts on one of the topics discussed: appointing the health care agent.
Choosing a Health Care Agent
Attorneys can add important value to the advance directive drafting process and to the clients’ thinking about advance directives. With the Health Care Power of Attorney, you have the opportunity to help clients be thoughtful about their choice of health care proxy. The guiding responsibility: to think about the best way for the clients’ wishes to be honored.
A. Share with clients the skills and qualities of the ideal healthcare proxy
The agent should be someone who can:
- advocate for the patient with doctors, hospitals, and the medical community generally;
- manage conflict within the family
And while there is no such thing as a perfect agent, there is always the “best-possible agent” from among the client’s options.
B. Counsel clients not to assume that their spouse is the best choice
While it is understandable that most clients do choose their spouse or significant other as their agent, sometimes spouses are simply not the best equipped to fulfill this role. A spouse may not be able to handle conflict, for example. If you recognize this, you should advise the client to select another party. But even beyond the obvious cases where the spouse is the wrong choice, you should broach this concept with clients in ways that will make the topic comfortable and safe for them to consider and discuss:
- Introduce the idea in the third person (e.g. “some of my clients find that their spouse actually isn’t the best person to make these decisions…)
- Use specific client examples – real or fictional stories war stories of clients who inappropriately chose the spouse
C. Do not appoint co-agents
While attorneys have differing opinions on this and states also vary, the experts who spoke to this point strongly recommended naming only one agent. Clients who want to appoint co-agents usually have multiple adult children whom they want to be involved.
Solutions for this include:
- Having an understanding that there is a single decision-maker but shared information between the agent and the other siblings
- Even including language in the HCPOA that the agent must reasonably consult with the other adult children – for instance before making an important decision
D. Help clients make the family comfortable with their choice of agent
As counsel, the attorney’s role is also to help clients think about how the family moves forward after the death of the client. It’s important that the adult children or the spouse who is not chosen as the agent feels OK about this decision. Counsel your clients to talk about their choice of agent with the loved ones(s) whom they didn’t name – and to explain their thinking. Often this can be done in very compassionate terms, e.g. “I knew it would be too hard for you to make these decisions…”
Randi J. Siegel, MBA, is the President of DocuBank, the largest advance directives registry in the U.S., which ensures that the healthcare directives of its 190,000 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. She is active in health policy pertaining to advance directives and serves as a Senior Fellow at the Jefferson School of Population Health in Philadelphia. Randi is an ongoing contributor to the Academy blog.
Academy Guest Blogger
American Academy of Estate Planning Attorneys, Inc.
9444 Balboa Avenue, Suite 300
San Diego, California 92123
Phone: (858) 453-2128
www.aaepa.com
Each New Year, we talk about how to better ourselves ― eat well and exercise, watch less television, spend more time with family, etc. And while determining how to live a healthier and more personally fulfilling life is an admirable goal, there’s another question, I think, to ask ourselves at the New Year: what can we do to effect positive change not just in ourselves, but in others? How can we, individually, make the world a better place?
One of my friend’s family members was recently diagnosed with terminal cancer. She did not expect this, and she is not prepared. Her wishes have not been recorded. And it’s hard for her to even think, let alone plan, when she feels so sick from the chemotherapy. Her family is arguing about what is best for her, and how to make it happen. This has already led to serious clashes that may take years to fully heal, and this process is just beginning. And the fact that my friend is in a family business just makes the dynamics all the more charged.
I’d like to say my friend is alone in this challenging circumstance, but as we all know, she’s not. When someone passes away, or is diagnosed with a terminal illness, families may argue. And if that person hasn’t planned in advance, the process can become even more difficult, sometimes tearing families apart entirely.
Unlike many people, we have been granted the opportunity to help others, to improve the world through our work. As attorneys, you help create and execute people’s wishes for the ends of their lives and after their deaths, through their healthcare and estate planning documents. As a healthcare directives registry and electronic document repository, we help ensure that these wishes can be known, available, and followed when it counts. It can be easy to forget amidst the day to day, but with these acts, our efforts can help simplify the complications that arise toward the end of life and after. These actions can help hold families together at the most critical of moments, when they might otherwise split at the seams. What a blessing it is that we have the opportunity to help others, just by doing our jobs.
Self-betterment is a great goal for the New Year, but helping others is at least as important. Clearly, the volunteer activities that we engage in throughout the year are an obvious way to give back. But at this time of year, I think it’s also useful to take a moment to reflect on the fact that this work is not just a source of income; it’s also a service, a means of helping others. As we go forward into this New Year, let’s pledge to renew our efforts to offer good counsel in helping people make the difficult decisions, to support them with these documents when they are needed, and to prevent unnecessary pain for family members when the time comes.
Wishing you a Happy New Year and good works in 2012.
Randi J. Siegel, MBA, is the President of DocuBank, the largest advance directives registry in the U.S., which ensures that the healthcare directives of its 190,000 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. She is active in health policy pertaining to advance directives and serves as a Senior Fellow at the Jefferson School of Population Health in Philadelphia. Randi is an ongoing contributor to the Academy blog.
Academy Guest Blogger
American Academy of Estate Planning Attorneys, Inc.
9444 Balboa Avenue, Suite 300
San Diego, California 92123
Phone: (858) 453-2128
www.aaepa.com
Newly released online: a short video encouraging Americans to think about their health care wishes.
Accompanied by moving music, it aims to reach the viewer emotionally as well as intellectually ― more so than I’ve seen in other video pieces on this topic. In fact, its tone reminds me a bit of the emotional ASPCA ads similarly-produced with only music, text and photos.
You might find this 3-minute piece useful to share with clients. It could be viewed in your office while clients wait for their initial consult, as homework before clients complete their healthcare directives with you, or during an educational presentation you might give in your community.
This video might also be an interesting way to reach out to existing clients at the holiday season. While your clients have obviously already completed their directives, it’s just as important that they talk about their wishes with their loved ones. And while this can be hard for them to do, it can be a tremendously important gift to their families. A short video like this to share with loved ones might give them a tool to start the conversation.
The National Healthcare Decisions Day (NHDD) initiative is hosting this video on its website (on the homepage) and adapted it for national use, as another vehicle to encourage advance care planning.
If you have any tools or ideas that you use to help clients have this conversation with their loved ones, please let me know.
Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), the largest advance directive registry in the U.S., which ensures that the healthcare directives of its 190,000 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. She is active in health policy pertaining to advance directives and serves as a Senior Fellow at the Jefferson School of Population Health in Philadelphia. Randi is an ongoing contributor to the Academy blog.
Academy Guest Blogger
American Academy of Estate Planning Attorneys, Inc.
9444 Balboa Avenue, Suite 300
San Diego, California 92123
Phone: (858) 453-2128
www.aaepa.com
Making decisions about medical care can be a daunting proposition – we know this from our own experiences. Start with the sophistication of diagnoses, add the complexity of medical procedures, and top it off with a menu of treatment options. Deciding what to do can be a recipe for anxiety, paralysis and/or self-doubt – even among those who are highly informed.
A new book takes on the task of helping people make the medical choices that are right for them. Your Medical Mind, by Drs. Jerome Groopman and Pamela Hartzband, begins with a fundamental assumption: there is often more than one correct decision for patients. It then tackles how patients can go about determining what care they want. In addition to coaching readers to gather the factual information about their options, the authors help people understand how their personal values – their goals, dislikes, and fears – can inform what medical decision is best for them.
Your Medical Mind helps people understand how they view medicine and medical treatment, whether as doubters (who tend to worry about the side effects or risks of treatment) or believers (who are convinced that the treatments or approaches will work and prefer to “do something”) or as a blend between these two extremes. They also suggest that patients look at the effect that the options will have on their lives and why these either matter or don’t matter to them.
Understanding and recognizing this can help patients make choices they are more comfortable with, and it can help doctors guide these patients to choices that are better suited for their beliefs and values. For instance, one patient didn’t want surgical thyroid removal for Grave’s disease because he didn’t want to be forced to take a pill every day. Another preferred the surgery because he wanted to “just get it over with” and move on with his life.
The significance of this book’s approach to decision-making is amplified when clients are faced with serious or end-of-life decisions about care. This is exactly the role that advance directives try to play. And it is also, I would argue, exactly the kind of conversation that’s particularly important for patients and health care surrogates to have. It is important for clients’ health care agent(s) to know, fundamentally, what the clients’ goals are when facing an end-of-life or other serious condition. And this includes even going that next step further – WHY is that the goal? Or WHAT does the person like or not like about that option? This will help clients communicate to their agent what’s really important to them. Is the goal to live without pain? To be able to tell jokes and watch Sunday afternoon football regardless of one’s physical abilities or limitations? To be able to take a Sunday afternoon stroll, even if one’s memory is lacking?
This book, and others like it that attempt to help clients dig below the surface level of their decision-making, may be useful tools for clients and their loved ones. It may be especially helpful to clients and their agents in talking about some of the big end-of-life treatment questions. Having additional language and another way to frame the conversation can only help.
Please let me know if you recommend any tools or resources that help clients and their surrogates improve their communication, complete more informed advance directives, or make better medical decisions. I am interested in learning from your experiences.
Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), the largest advance directive registry in the U.S., which ensures that the healthcare directives of its 190,000 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. She is active in health policy pertaining to advance directives and serves as a Senior Fellow at the Jefferson School of Population Health in Philadelphia. Randi is an ongoing contributor to the Academy blog.
Academy Guest Blogger
American Academy of Estate Planning Attorneys, Inc.
9444 Balboa Avenue, Suite 300
San Diego, California 92123
Phone: (858) 453-2128
www.aaepa.com
An important new study about advance directives was just released October 5 in the Journal of the American Medical Association (JAMA). You and your clients may have already heard about this in the news.
The study’s findings are generally favorable (and certainly not unfavorable) toward advance directives. But — some of the press coverage has the potential to confuse clients or cause them concern about the purpose of the advance directives that you helped them create. Specifically, some of the coverage describes advance directives as a “cost-saving measure” or as “not effective.”
Here are some of the main points from the JAMA study that may be important for your firm and your clients to understand should clients ask you about this study:
- This study looked at patients who wanted less aggressive treatment at the end of their lives. It used cost of care as the proxy measure of the treatment received, hence the reporting focus on costs.
- The findings suggest that people with advance directives who wanted less aggressive end-of-life care did have their wishes met. Specifically:
- this group of patients did not have everything medically possible done for them, as measured by their lower costs of care.
- these patients had a higher rate of dying outside the hospital (a measure of less aggressive care)
- these patients had higher rates of using hospice and palliative care (comfort and pain management) services
- In certain areas of the country, advance directives helped patients achieve their goal of less aggressive treatment. In other areas, advance directives were not necessary for people to have their wishes met because of less aggressive treatment norms there.
- The study did not find or even suggest that advance directives were used as a cost-cutting measure. Nor does it suggest that patients received less care than they wanted for any reason. In fact, the study did not evaluate the care of patients who specifically stated in their advance directives that they wanted the most aggressive treatment possible (to determine if advance directives helped them achieve this goal).
In closing, this study suggests that having advance directives either helped or at worst had no effect on patients getting the less aggressive care that they wanted at the end of their lives. It did not find that advance directives were counterproductive to these patients receiving their desired care.
If you have any questions about this study or its meaning for your clients, please feel free to call me at 610-667-3524 or email me at rsiegel@docubank.com.
Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), the largest advance directive registry in the U.S., which ensures that the healthcare directives of its 190,000 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. She is active in health policy pertaining to advance directives and serves as a Senior Fellow at the Jefferson School of Population Health in Philadelphia. Randi is an ongoing contributor to the Academy blog.
Academy Guest Blogger
American Academy of Estate Planning Attorneys, Inc.
9444 Balboa Avenue, Suite 300
San Diego, California 92123
Phone: (858) 453-2128
www.aaepa.com
According to a recent study by the Mind Perception and Morality Lab at the University of Maryland, people view patients in a persistent vegetative state (PVS) as worse off than patients who have died. Published online in Cognition (http://www.sciencedirect.com/science/article/pii/S0010027711001752), the study consisted of three experiments. Here is the Abstract:
“Patients in persistent vegetative state (PVS) may be biologically alive, but these experiments indicate that people see PVS as a state curiously more dead than dead. Experiment 1 found that PVS patients were perceived to have less mental capacity than the dead. Experiment 2 explained this effect as an outgrowth of afterlife beliefs, and the tendency to focus on the bodies of PVS patients at the expense of their minds. Experiment 3 found that PVS is also perceived as “worse” than death: people deem early death better than being in PVS. These studies suggest that people perceive the minds of PVS patients as less valuable than those of the dead – ironically, this effect is especially robust for those high in religiosity.”
The complex views of PVS illuminated in this study further illustrate the importance for clients to be clear in advance about their medical wishes and to not assume that others will be able to infer what they would want. It also speaks to the possibility that people may hold simultaneously conflicting views about PVS when making decisions on behalf of a loved one in a persistent vegetative state.
Randi J. Siegel, MBA, is the President of DocuBank, the largest advance directives registry in the U.S., which ensures that the healthcare directives of its 190,000 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. She is active in health policy pertaining to advance directives and serves as a Senior Fellow at the Jefferson School of Population Health in Philadelphia. Randi is an ongoing contributor to the Academy blog.
Academy Guest Blogger
American Academy of Estate Planning Attorneys, Inc.
9444 Balboa Avenue, Suite 300
San Diego, CA 92123
Phone: (858) 453-2128
www.aaepa.com
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