In teaching financial literacy to audiences across the country, I often cover the topic of "End of Life Planning." Included in this part of the course I will inform the attendees of the importance of planning ahead in this arena, and not letting someone else make these crucial life decisions on your behalf. A living will, health care proxy and planning hospice treatments are a few of the areas I cover. Living wills and health care proxies are very critical documents and every independent citizen, young and old, should have these documents within his or her estate plan.
Living Will -- Advance health care directives, also known as advance directives or advance decisions, are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity.
Health Care Proxy -- An instrument (or document) that allows you to appoint an agent to make health care decisions in the event that the primary individual is incapable of executing such decisions.
Both documents together are crucial in any estate plan. The living will allows an individual to outline what he/she would want to happen if they are ever incapable of making decisions about his or her life due to illness or incapacity. For instance, if you are ever in an accident and left in a vegetative state, would you want the doctor to "pull the plug"? This decision, without a living will, would be left up to debate by doctors and family members. A living will allows you to outline exactly how you want to be treated. If you know that you would want to be kept on life support for as long as possible as long as there are any life signs, you can write that into your living will. Conversely, if the fear of living your life as a "vegetable" is too much for you to bear you can have your wishes to be removed from life support earlier. The choice is entirely up to you but nobody will ever know that you even have a preference unless you have a living will.
The health care proxy, is the document that essentially appoints whom you would want to have carry out the wishes outlined in the living will. So continuing in the same example above, you would have the option of naming your doctor, best friend, mother or another trusted person as the person who fulfills the instructions of the living will. What is important to remember is that whomever you name as the agent with your health care proxy has a duty to make executing decisions based upon your wishes.
In my financial literacy courses I suggest that you name your trusted physician as the agent in your health care proxy, especially if he/she has been your physician for a period of time. You should also have regular conversations with your physician that allow you to discuss with him or her exactly how you would like to be taken care of. These conversations are critical because they allow you to make these decisions while you still have a voice. The living will and health care proxy provide you with that voice and the regular conversations with your physician are there to insure that your physician is perfectly clear of your wishes and desires.
In a version of the new proposed health care reform legislation, it is proposed the government provide funding for individuals to have one of these critical conversations every five years with their physician. Somehow, there have been many false statements made about the purpose of these conversations. Below are a few quotes that demonstrate how many have been perpetuating misrepresentations (or blatant lies) of this proposed legislation.
On a radio show on July 16, former Republican Lieutenant Governor of New York Betsy McCaughey said she had read the bill and made some disturbing discoveries. She stated the following:
"Congress would make it mandatory... that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner, how to decline nutrition, how to decline being hydrated, how to go into hospice care... all to do what's in society's best interest... and cut your life short."
House Republican Leader John Boehner (R-Ohio) and Republican Policy Committee Chairman Thaddeus McCotter (R-Mich.) issued a joint statement stating the following:
"Section 1233 of the House-drafted legislation encourages health care providers to provide their Medicare patients with counseling on 'the use of artificially administered nutrition and hydration' and other end of life treatments, and may place seniors in situations where they feel pressured to sign end of life directives they would not otherwise sign," they said. "This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law."
Former Governor of Alaska stated that the new proposed legislation was an attempt to mask the government's desire to cut costs by refusing treatment and she stated the following:
"And who will suffer the most when they ration care?" Palin asks. "The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care. Such a system is downright evil."
The specific area dispute within the legislation, of which I have read all 1018 pages of bill HR3200, comes on page 425 in subsection (hhh)(1) where it discusses "Advance Care Planning Consultation". It states the following:
"[T]he term 'advance care planning consultation' means a consultation between the individual and a practitioner described paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years."
It goes on to describe what the consultation will consist of which includes an explanation of advance care options, explanations of advanced directives, the roles and responsibilities of the health care proxy, resources available, end-of-life services and supports available, and benefits available for advanced care services. This topic is by far not the most optimistic or cheerful topic to be discussed but is necessary to be addressed so that we can be better prepared for these scenarios that occur in many of our lives. In addition, these conversations should not be restricted to the elderly as in many cases those who are younger have unfortunate accidents or illnesses that require advanced care planning.
While many people are focused on page 425 of the bill, I would suggest that they turn to pages 426 and 427 which state the following in section (III) as it relates to the explanation of the orders regarding life sustaining treatment that has so many people alarmed:
"(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of the individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decision maker (also known as a health care proxy.)"
The key phrase that I underlined and will state again as it debunks all of the misrepresentations (or blatant lies) that have been told reveals the following:
"[S]o that the treatment wishes of the individual will be carried out if the individual is unable to communicate those wishes".
The wishes of the doctor will not be carried out, nor will the wishes of the government be carried out...the wishes of the individual will be carried out. There is no "death panel" when life sustaining treatment is being considered. There are no conversations about how to end one's life sooner nor are there pressures on seniors to sign end of life directives. While these conversations are not the most fun to have, this bill does nothing more than promote the education of the people about the options that they have, and the resources that are available, in the same way that I educate people in my workshops. If you have a health care proxy, living will, or even a durable power of attorney, you ensure that your wishes will be carried out.
Knowing what I know, I am certain that to encourage people to have a living will, health care proxy, and to have regular conversations are wise and a valuable component of ANY financial plan, young or old. Are the politicians ignorant of this information, or are they knowledgeable about the importance of these items but choose to use this time to twist the words of others to insight fear?
If it is the former, this is a huge concern of mine, and should be a concern of yours. To have legislators attempting to legislate an issue about which they themselves are not familiar cannot be good for the country. If it is the latter, this should also be a tremendous concern. As we see from the violent, and disruptive town hall meetings across the country there is strong fear brewing throughout the country as people are comparing Barack Obama to Hitler because he apparently is going to start a crusade to kill the elderly or disabled...this far from the truth and embarrassing to even acknowledge.
The answer to the politics of fear or ignorance lies within the reason that I am writing this article. We need to have a massive crusade of educating the public starting with you. Barack Obama and the Democratic Party have not been as aggressive as they should be to explain the contents of the proposed health care reform to the American people. In the least, they are definitely not as aggressive as those who are out to play upon the lack of knowledge within America making it easy to insight fear within American people by spreading lies. While we need the President to increase his outreach with more concrete explanations, as this reform may comprise up to 17% of the nations GDP we must all increase our efforts to learn about this legislation and assist to educate our community. You can read the bill for yourself on line as I did, attend town hall meetings, and do what it takes to become knowledgeable enough to help our government spread the message of the true contents of this legislation. Ignorance and fear have no place in the home of the educated and well-informed.
No matter your age, if you are an independent citizen you should have a living will, health care proxy, or durable springing power of attorney. You would be wise to have regular conversations with you physician at least once every five years. You need to educate yourself of the resources that are available to you to make sure that, God forbid, you are ever in a position where you are unable to make life sustaining decisions due to illness or incapacity. In the same vein of nobody expecting to lose their job so they should have 6 months of living expenses saved, nobody expects to suffer a severe illness leaving them incapacitated so we all need to prepare ourselves. The essence of financial planning is preparing for the worst but expecting the best. This is not National Socialism, this is good sense.