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Making End of Life Decisions

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Death can be an exhausting, confusing, and even terrifying process for everyone involved. Yet, despite the immense emotional burden that a dying person’s family must bear, there are still many complex medical and legal matters that must be taken care of before a dying person takes their final breath. Below are just a few of the important considerations that must be kept in mind during a person’s last months, weeks, and days.

Discussing Your End-Of-Life Wishes

Having an informal discussion with your loved ones about end-of-life wishes is probably the best way to start this difficult process. It’s very common for these discussions to take place years or even decades before an illness or other medical concern brings the topic of death to the fore.

Due to not being faced with the immediacy of death, it’s much easier in this context to have candid, in-depth conversations about how you want to confront your own death. Though your children and loved ones may shy away from such seemingly macabre discussions, it’s imperative to make sure that they understand what you want, and it’s much easier to do so if you’re still healthy.

Do you want heroic measures to be taken? Do you want to have a DNR order put in place? Would you want to be placed on a respirator? Do you want to be taken home to die? These are all complicated and very difficult questions, but their difficulty is balanced by the absolute importance of their answers. Sometimes, when the end of a person’s life is nearing, they are no longer able to answer these questions. Don’t assume that you will have the opportunity to discuss your wishes by the time it’s clear that you are dying.

By having these discussions beforehand, it becomes easier to anticipate what needs to be done–documents written, living trusts amended, etc.–in order to ensure that your end-of-life wishes are honored when the time comes. Even if you don’t establish formal written directives, doctors often consult with loved ones to determine what an uncommunicative person would desire, in their current medical condition. If you can trust your loved ones to put your wishes before your own, they can make sure that you receive the medical care that you desire.

Writing An Advance Directive

Many familiar legal documents, such as wills and living trusts, are examples of documents called “advance directives.” An advance directive is simply a written document that indicates what a person wants to happen when they are seriously ill or pass away. When it comes to medical care in the state of California, there are two important documents that you should prepare ahead of time to ensure that your wishes are fulfilled:

  • A durable power of attorney. In California, a “durable power of attorney” is a document in which you name a person you trust to make decisions about your medical care, if you are unable to do so. You can also grant that person (or a different person) a durable power of attorney giving them the power to make financial decisions for you as well. If you are making your power of attorney document long before you anticipate it will be relevant, you should consider what the future situation may be like. If your spouse is similar in age to you, they may be too old to act on your behalf when the time comes. In this case, you may want to give one of your children, or another younger relative, power of attorney instead.
  • A living will. In a living will, you can describe exactly what sorts of medical treatment you do or do not want if you are suffering serious health issues. This is a way for you to draw the line between receiving medical care that could save your life and give you a good quality of life, and care that will merely keep you alive. A living will is a good way of making absolutely sure that your wishes are known, and can take some of the pressure off of the person you’ve given power of attorney: it can be much easier to make a difficult decision if they can simply provide your doctor with a copy of your living will, rather than feel like they are the one making a decision that will end or shorten your life.

Together, these two documents form what is commonly referred to as an “advance health care directive.” By putting an advance health care directive in place, you can make sure that family members won’t make medical decisions that are in their own best interest, but instead use “substituted judgement,” meaning they make the decisions that you would make for yourself, if you were able to.

These documents are critical for avoiding the sort of legal wrangling and painful family disputes that can arise in situations like that of Terri Schiavo a few years ago. Advance health care directives serve to not only ensure that your wishes are honored, but also to avoid disagreements that can cause serious permanent damage to the relationships between your family members.

Your Right To Die

If you are a resident of California, then you will have to make a decision that may be the most difficult you have ever faced: If your quality of life falls below a certain point, do you want a doctor to help you die?

Chances are you’ve seen in the news that in October of 2015, Governor Jerry Brown signed ABX2 15, the “End of Life Option Act.” Under the law, commonly referred to as the “Right-to-Die” law:

  • If a person at least 18 years old is terminally ill, they may request that legal drugs be prescribed to them. (It’s wise to discuss this with a doctor ahead of time, to make sure that they are amenable to the treatment.) The person must make two oral requests for assistance to die, separated by at least 15 days. Then the person must submit a written request, which must be signed with at least two witnesses. This is done to make sure that a person does not make an impulsive decision.
  • Two doctors, a consulting physician and an attending physician, must be in agreement that the person is expected to live for less than six more months.
  • Physicians must then evaluate the person, and determine whether they are mentally competent, and whether their wishes unacceptably skewed due to depression, or external factors such as financial worries.
  • If the person is found to be mentally competent, then a doctor may prescribe the drug or drugs to be used to end the person’s life. This will probably be pentobarbital or secobarbital, and may be accompanied by other drugs to prevent the nausea that either drug can cause.
  • The patient will then be provided with the drug, which is taken by drinking it. The person must ingest the drug on their own, without assistance. Nobody, including a doctor or loved ones, can assist with the administration of the drug. People who are too weak to give themselves themselves the drug, or who cannot effectively take the drug orally, are not eligible for the life-ending treatment.
  • It should be noted that hastening one’s own death via this route will not affect a life insurance policy. The death certificate of someone who uses the right-to-die option will indicate that they died of their terminal illness.

As you can see, choosing to end your life via the End of Life Option Act is a complicated process. You cannot specify a desire to receive assistance in dying through an advance directive. Also, patients with illnesses such as Alzheimer’s or dementia are ineligible for the treatment, due to the fact that by the time their illnesses become terminal, they do not have the mental soundness necessary to legally choose to die.

If you wish to die, it’s advisable to discuss your wishes with family. However, the decision must be entirely your own. In fact, doctors will carefully interview patients in private to determine if they are being coerced by other people. Anyone who attempts to coerce someone into requesting assistance with dying can be charged with a felony. You are the only person who can make this decision for yourself.

Seeking Legal Assistance For End-Of-Life Concerns

As we said above, dying is extremely stressful, and very complicated in a legal sense. For anyone who is going through the process of deciding their last wishes and establishing what medical care they want to allow, it’s advisable to consult with a lawyer experienced in this field. If you would like assistance, you are welcome to contact us at any time by calling us at 916-400-4516, or emailing us through our site’s contact form. We will be happy to answer any questions you may have, and do everything we can to help you create a legal framework for your end-of-life decisions.