One Vital Step This Doctor Wishes Everyone Would Take

Q. A few years ago, when we first got married, my husband, Logan, and I decided to paint the living room in our new home. It sounded like a great idea at the time, but we didn’t get very far. We ended up hiring someone, but kept the super heavy-duty face masks we bought for the project. This past month, we dusted off the packages and have been putting the masks to use to protect ourselves from COVID-19.

We’ve been really good about staying inside and social distancing to avoid getting coronavirus. We haven’t left the house, unless we had to walk the dog, and we’ve gotten grocery delivery for the most part. We’ve kept in touch with family and friends over Zoom, have been reading lots of books on Kindle, and my husband started learning a new language for a trip we hope to take in the future. It sounds like we are doing all the right things to stay well and healthy, but my mother insists we get our incapacity planning documents in order, just in case. “You can never be too prepared,” is her mantra. But we are only in our early thirties! I can understand my mom being concerned about herself and my dad, as far as planning goes. But why should young people like ourselves worry about such things?

A. Whether you are 25 or 85 or somewhere in between, there is no better time than the present to get your estate planning and incapacity planning in place.

Dr. Asha Shajahan, a fellow at Harvard University, is a primary care physician who is treating inpatient and outpatient COVID-19 patients as well as homeless people who may have the virus. She and I are certainly on the same page when it comes to the need for incapacity planning, particularly at this uncertain time!

Earlier this week, Dr. Shajahan watched a 30-year-old patient with COVID-19 pass away on a ventilator. This patient hadn’t ever discussed his end-of-life wishes with his family or friends and had no legal documents in place, so no one knew of his wishes. His father, who watched him suffer, didn’t want any further treatment that would prolong the inevitable. His mother, however, wanted to try everything that could possibly be done to save her son. This led to a heartbreaking conflict at an especially sad and stressful time. Of course, he hadn’t planned to die, but if he had his incapacity planning documents in place, his wishes would’ve been known to his loved ones. The tragic situation described above is all too common, a result of families failing to discuss emergencies and end-of-life wishes ahead of time.

In another similar situation, the sister of one 37-year-old patient said tearfully, “I don’t know what he would want ― making this decision for him is too stressful.” This patient also didn’t have an advance directive in place. His sister now had the emotional burden of deciding his care. She too was fighting COVID-19 but from home. Her brother was on a ventilator, unable to communicate. According to Dr. Shajahan, “(t)o say it’s an overwhelming situation to be in is an understatement.”

It’s Important to Make Choices Before a Crisis Occurs

Out of the 55 patients in Dr. Shajahan’s COVID-19 unit, only one had an advance care planning document. That patient was nonverbal after having a stroke at the age of 54. Dr. Shajahan phoned the patient’s sister, his designated legal guardian, and she read his advance medical directive to him. “Doctor, tell him I love him,” she also said. It was comforting to know that this patient had a plan and a designated and advocate.

During her last several night shifts, Dr. Shajahan continued talking to patients about advance directives. “Do you want to be resuscitated including being on a ventilator, having electric shock applied to your chest and chest compressions that can break your ribs?” I asked. “Would you want a feeding tube?” “If you were unable to make medical decisions, who do you want to make those decisions for you?” These questions aren’t easy to answer, especially when you are already sick and terrified and isolated in a lonely hospital bed.

National Healthcare Decisions Day Emphasizes the Need to Plan Ahead

Just last week, we celebrated National Healthcare Decisions Day (NHDD), a day that exists to inspire, educate, and empower the public and providers about the importance of advance care planning. NHDD, run by The Conversation Project, exists as an annual initiative with the key goal being to encourage people to express their wishes regarding healthcare and for providers and facilities to respect those wishes, whatever they may be.

To say that this COVID-19 pandemic is a challenging time is a vast understatement — for most people this is the most challenging time we have ever lived through. There are many things that are out of our control. But there are some things we can do to help us be prepared — both for ourselves and the people we care about.

Only 1/3 of Patients Have Their Incapacity Planning Documents in Order

A review of studies from 2011 to 2016 conducted by researchers at my alma mater, the University of Pennsylvania, found that only about one-third of American adults had advance medical directives.

Dr. Shajahan believes that this is a talk everyone should have. So, while we are social distancing in our homes, it’s time to have that conversation that most of us have avoided ― or didn’t even know we needed to have. According to The Conversation Project, here are four important things each of us can do, right now, to be discuss wishes in advance.

1. Choose a health care decision maker (often known as a health care proxy or medical agent) — a person who will make medical decisions for you if you become too sick to make them for yourself.

  • You can use this simple guide to help you choose a health care decision maker.
  • Make a plan to talk with your decision maker as soon as possible. Phone calls or video chats are good if you don’t live with that person.

2. Have a talk with your health care decision maker to make sure they know what matters most to you.

  • The Conversation Starter Kit can help you get ready to talk to others about what matters most.
  • If you have already completed the Conversation Starter Kit or have an advance directive and other incapacity planning documents in place, review them with your loved ones to see if you want to make any changes or updates, especially in light of the current pandemic.
  • After you talk to your loved ones about what matters, talk to your health care team. Knowing what matters to you helps your care team provide better care that’s right for you.

3. Think about what you would want if you became seriously ill. Think about what you would want if you became very sick at this time. Here are some questions to ponder:

  • What would be most important to you? (Examples: Being comfortable. Trying all possible treatments.)
  • What are you most worried about? (Examples: Being alone. Being in pain. Being a burden.)
  • What is helping you through this difficult time? (Examples: My friends. My faith. My cat.)
  • If you became very sick with COVID-19, would you prefer to stay where you live or go to the hospital?
  • If you chose to go to the hospital, would you want to receive intensive care in the hospital?
  • What treatments to use or avoid if you become very sick.
  • List any other questions or concerns you want to bring up with your friend/family/provider.

4. Once you’ve discussed your wishes, take action and get your planning documents in place with the assistance of experienced estate planning and incapacity planning attorneys, such as those at the Farr Law Firm. Learn how to make your wishes legally sound so if there is any kind of dispute between family members, there will be a clear path forward.

Healthcare Workers and First Responders Often Don’t Plan Themselves, But They Certainly Should

According to Dr. Shajahan, “As often as we address advance directives for others, many of us in health care have not thought of our own mortality. I hadn’t. Too often, this conversation is saved for a Medicare wellness visit with an outpatient doctor at the age of 65. But this is a talk everyone should have, not only at the magic age of 65.” And, following the conversation, to make your end-of-life wishes legally enforceable, having incapacity planning documents in order is imperative.

There is no better time than the present to start planning. To thank first responders an healthcare workers for all they are doing on the frontlines during the coronavirus pandemic, the Farr Law Firm would like to extend a special 50% discount to them for our Level 1 Incapacity Planning, which includes a General Power of Attorney, Real Estate Power of Attorney, our proprietary 4-Needs Advance Medical Directive®, a HIPAA Waiver, Docubank Registration, and more; we are also offering a 50% discount on a Last Will and Testament. Offer good until May 31, 2020. Call us to make a virtual or in-office appointment for an initial consultation today at 703-691-1888.

Any Time After You’ve Turned 18 Is A Good Time to Start Planning

As you can see, it’s important to make decisions and have conversations with loved ones and with medical and legal professionals letting them know your personal preferences before you find yourself in a crisis situation. Any time after you’ve turned 18 is a good time to start planning, especially since the current pandemic is tragically affecting people of all ages.

Once the important conversation with your loved ones (and your physician, if you choose) occurs, and important decisions are discussed, it is important to get proper incapacity planning documents in place. Our proprietary 4 Needs Advance Medical Directive® includes:

1) a health care power of attorney;
2) our proprietary Long-term Care Directive®;
3) a near-death directive; and
4) an after-death directive.

When you or your loved ones are ready, please call us to set up an appointment for an initial consultation. For those who feel safer in their homes, we offer phone appointments, video conference appointments, and curbside signings (but we are still open for in-person meetings and signings for those who desire it, of course with everybody wearing appropriate face coverings):

Estate Planning Fairfax: 703-691-1888
Estate Planning Fredericksburg: 540-479-1435
Estate Planning Rockville: 301-519-8041
Estate Planning DC: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.