End of Life Decisions

Did you know?...

• 80% of all deaths in the United States occur in an institutional setting* and,

• 80% of institutional deaths are the result of a specific, explicit decision to limit life-sustaining or life-saving care*.

Are you prepared?

A Durable Power of Attorney for Health Care (aka Medical Durable Power of Attorney) names persons you trust – as your Agent – to convey health care decisions in the event you cannot communicate for yourself. “Durable” means that the agent’s power survives your incapacity; i.e., the document confers your intent that the agent’s authority shall be exercisable on your behalf during later disability or incapacity.

Pursuant to WA statute, the expectation of your Agent is to (1) determine what treatment decision you would have made if competent (called “substituted judgment”); or (2) if such determination cannot be made, the decision to refuse or consent to treatment should be based on the patient’s “best interests.”

Generally in Washington, even an incompetent individual who is not comatose or in a persistent vegetative state has the right to refuse life-sustaining treatment when in an advanced stage of an incurable and terminal (6 months at most to live) illness and is suffering severe and permanent mental and physical deterioration. Life-sustaining treatment includes artificial means of hydration and nutrition.

Be proactive:

Talk to your doctor about end-of-life issues. Then, discuss what you would and wouldn’t want under various end-of-life circumstances with your potential Agents – before and after naming them – to ensure that they know what health care actions you want them to take on your behalf, especially regarding life-sustaining treatments. Next, visit GA and give your agents the power to act for you.

As part of your estate plan, GA will prepare your Medical Durable Power of Attorney and the companion documents, living wills and anatomical gifting directives.

Educate yourself going forward:

Decisions of the Washington Supreme Court afford guardians, agents, and family members significant discretion to make end-of-life decisions, in consultation with health care providers; and with no requirement for court supervision or involvement.

Contributing Author of this BLOG: Etienna Bachand, Supervising Paralegal, Gregorek and Associates, PLLC.

*Jeffrey M. Sconyers (Vice President and General Counsel, Children’s Hospital & Regional Medical Center) and his acknowledgement of Annette Clark (Professor of Law, Seattle University School of Law). “Elder Law at the Cutting Edge: Annual Fall Elder Law Conference” September 15, 2006, Seattle, WA.