Barbara Bush, former first lady, passed away recently after declining further medical treatment and instead deciding to pursue palliative care. Palliative care is also referred to as comfort care or hospice care. Individuals suffering from terminal illnesses with no chance of cure may elect to forgo medical treatment and instead obtain palliative care, which focuses on pain relief and maximal quality of life during one’s final days.
Barbara Bush had been suffering from congestive heart failure and chronic obstructive pulmonary disease. Both diseases have no cure and are eventually fatal. As these types of diseases progress, treatment can be painful and invasive but with diminishing returns. Rather than continue to be treated with what are often uncomfortable and/or expensive treatments, individuals may elect palliative care to stop treating their disease(s) and instead obtain pain relief.
Bush’s decision to “not to seek additional medical treatment and will focus on comfort care” brings to light end-of-life decision making. Since 2008, April 16th has been designated as National Healthcare Decisions Day, which “exists to inspire, educate and empower the public and providers about the importance of advance care planning.” Modern medicine can work wonders, but it is not infallible- some diseases simply are not treatable. Instead, symptoms are managed after a certain point, and those management treatments can be painful, invasive or stress-inducing.
Part of the estate planning process often involves what one wishes to be done, from a medical standpoint, as they near the end of their lives. From medical directives (instructions to health care providers regarding what care an individuals wishes to have) to durable powers of attorney for medical decision making (appointing an individual to make decisions on one’s behalf when they are unable to do so), the palliative care discussion lingers throughout the process. For example, some people may elect provisions instructing health care providers to stop medical treatment and focus on comfort and pain relief when faced with a medical situation that is unlikely to be treated and/or when quality of life is likely to be very poor if treatment is successful.
The right to make a decision to ends on life is gaining popularity. Several states have passed laws, commonly called Death with Dignity acts, that allow certain individuals to elect to receive medication that will end their life. These Death with Dignity acts have constraints upon who can utilize the act, such as being mentally competent. Michigan currently does not have such an act, although several state representatives have introduced death with dignity bills.
Health care decision-making is a critical element of the estate planning process. Several considerations must be made: medical directives, agents to make decisions when one is unable to do so, whether to prepare a do-not-resuscitate order, what one wishes to have done with their body after death such as a donation to science and burial instructions and more. If you are considering an estate plan, or need a current plan reviewed or altered, contact Benjamin Long of Schmidt and Long.