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Directing Your Exit

By: Investor Solutions

**As seen on Forbes**

Frank Armstrong, III

Today you have an opportunity to direct your exit. You can write your life’s last act, but if you don’t a giant health care machine may give it an entirely different ending than you might prefer. You may not be the only actor on the stage. Given an opportunity the rest of the cast would like to take their cue from you.

The question is fraught with religious, moral, legal and personal dimensions that each of us must eventually face. None of this is trivial. But, who better than you to decide? And what better time to decide than now when you have all your resources available.

Surprisingly, almost all our clients when asked about their end of life preferences already have a strong opinion. But, not many of them have provided a written directive to friends, physicians and family members to insure that their wishes are carried out.

Most financial advisors don’t care what preferences their clients select, but they want to make sure that whatever choices they make, their wishes are carried out.

We have found that most people divide themselves into either “pull the plug” or “do everything and spend everything to extend life one more second”. In reality it’s not quite that simple. There are some more issues you should spell out.

Living Will Provisions (Also known as Advanced Health Care Directive or AHCD)

  • A medical power of attorney (MPOA).In the event you are unconscious or otherwise unable to express your wishes, appoint a family member, friend, or other person to make health care decisions in your place.

    If you fail to appoint someone your hospital or physician may appoint someone for you (health care surrogate). In the absence of a family member available and willing to serve that person might even appoint a hospital staff member. In this worst case scenario that person may have entirely different values than yours.

    Of course, while you are able to communicate and competent you are always in charge and can overrule any decision by your surrogate or appointee.

 

  • Health Care Directions. Here is where you make it known what kind of treatment you would like and what should be withheld. For instance, even if you don’t want surgery or chemo therapy, you might like pain relief even if it might hasten death. Do you want to be at home with hospice care, or remain in a medical facility? In the event your heart should stop, do you wish to be resuscitated?

    Of course, as long as you are conscious and competent you can always change your directives if your decisions change.

 

Family Considerations: it goes without saying that you should make your wishes known to your family, friends and physicians well in advance, and get their agreement. Knowing your desires relieves them from making some of the most painful decisions they will ever face. No one should have to live with the lingering doubt that they didn’t do what mother would have wanted. Relieving them of that burden may be your final gift to your family.

Forms for a living will are widely available, inexpensive or free, and easily customized to your preferences. Any financial planner, attorney, or even hospital should have them and assist you if necessary. Generally, the form should be witnessed and / or notarized. It’s never a bad idea to consult with a professional.

Two Cases

We have all seen this play out for better or worse.

In one tragic case here in Florida, Terri Schiavo, a woman in her prime years suffered a cardiac arrest leaving her in a persistent vegetative state. Absent a clear statement of her desires the machine took over. She was kept on life support for five years while family, religious leaders, press, politicians and physicians battled in court. I can’t even imagine the pain suffered by all concerned.

In another somewhat better example one of my childhood heroes was 86 going on 16 when she became concerned that she wasn’t snapping back after an extended round of holiday parties. By the time she was diagnosed with cancer it had spread too far to offer hope of treatment. She had been a famous entertainer in her earlier life and remained active in social, charitable and political affairs. She was also a well-known local party animal. A proud but not vain woman she made the decision to reject chemotherapy or surgery and “go out with all her hair and her dignity”. She elected to stay in her home surrounded by family and friends. Visiting hours were whenever she was awake. When she needed additional care she entered the hospice program but remained at home until her death. Her family understood her wishes and supported her decisions so that she could go out as she chose. All of us were extremely grateful that Mother made her wishes clear and relieved us of having to make those choices in a vacuum during a particularly painful and stressful time.