Medical Decision-making Controversies Your Clients May Be Talking About

Two very controversial articles and events became public in the last few weeks about health care decision-making and the right-to-die.

First, the story of 29 year old Brittany Maynard, who was diagnosed with a very aggressive, terminal brain cancer and ended her life about a week ago with the help of Oregon’s Death with Dignity Act, a law legalizing physician-assisted suicide.  Conveniently, the Academy’s Steve Harnett blogged about this just a few days ago, and I commend you to his piece for more information about various state laws on the subject, as well as to my prior blog post about the pros and cons of this policy.  And if you who want to dig in more deeply here’s more info from both sides of this law from a recent debate.

The second article, written by Ezekiel Emanuel, M.D., is “Why I Hope to Die at 75.”  In this piece, Emanuel explains the reasons why he feels that 75 is a good age to go. He starts by stating that all of his friends and loved ones think he’s crazy for wanting to die at 75. He responds by saying, “Doubtless, death is a loss… But here is a simple truth that many of us seem to resist: living too long is also a loss.”

In truth, Emanuel is not actually saying that he wants to die at 75 regardless of his medical condition. (He didn’t choose the article’s provocative title.)  What he’s really saying is that when he reaches 75 he’ll essentially “give up” on trying to live longer – in other words, no more preventive medical tests or procedures and only palliative or comfort care should he become ill.

Here’s his reasoning: for the vast majority of people, age brings decline, if not also disease. Minds and bodies slow with the passage of time, leaving people unable to move or think as they used to, to pursue the careers and other activities that were so important in earlier life. Emanuel admits, however, that there is more to life than career — that family also matters. But to him, family is just one more reason why 75 is a good age to die: it’s old enough that you’ve most likely gotten to spend valuable time with your children and grandchildren, imparted to them the knowledge you want them to have, yet young enough that they will be able to remember you as something more than feeble, fading, or worst of all, a burden, both financial and emotional.

Emanuel makes clear that he is not claiming we should all die at age 75, nor does he condemn those who wish to live longer. In fact, he strongly opposes the Death with Dignity laws described above. (He stipulates, among other reasons, that most terminally ill patients who want to end their lives are actually clinically depressed.)  What Emanuel says he ultimately hopes to accomplish with his article and arbitrary deadline is encouraging people to be conscious about the fact of death and to face the subject head-on — rather than trying to pretend that mortality does not exist.

Do you talk with your clients about medical decision-making or help them think through their goals for their advance directives?  Many estate planning and elder law attorneys do not, in my experience.  If you do, please let me know what you discuss and when in the client engagement.

Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), which ensures that the emergency information and healthcare directives of its 200,000+ enrollees are available 24/7/365 through the largest advance directives registry in the U.S., as well as access to an online safe for storage of digital assets and other vital documents. 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 Philadelphia Estate Planning Council, the International Society of Advance Care Planning and the Coalition to Transform Advanced Care, Randi is active in health education and public engagement related to advance care planning/advance directives. She serves as Pennsylvania liaison to the National Healthcare Decisions Day initiative and as a board member of the Center for Advocacy for the Rights and Interests of the Elderly. Randi is an ongoing contributor to the Academy blog.

Academy Guest Blogger 
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