Programming note: When we have brainstormed about future blog topics in our firm we often end up thinking “that’s too depressing!”. Many topics involved in estate planning might be viewed as depressing or difficult, especially during a pandemic. However, our hope is that by discussing these topics (sometimes with attempts at humor), we can help our readers feel more comfortable with tough topics. Hopefully, you’ll even be motivated to talk to your family and loved ones as opportunities present themselves.
With that in mind, this particular blog post has been sitting in our “potential blog topics” for a while. However, watching the news lately, we hear of ER doctors and nurses who are struggling with the idea of being forced to allocate limited medical supplies and care among people. How will the medical professionals decide who gets the ventilators? What if there are not enough beds in the facility? Who will be sent home?
As difficult as this discussion is, especially now during Covid, it brings to mind a book that suggests that we consider the possibility that Americans may have adopted a practice and philosophy of (over)treating everyone (even those who may be older and have other health issues), without taking into consideration such factors as quality of life, prognosis, etc.
I’m old enough to remember when we could hop on an airplane and travel outside of the state in a carefree manner for a long weekend away. On one of the trips I took pre-COVID, I stopped at a store in the airport and picked up the book I’m referring to. The title caught my attention: “At Peace: Choosing a Good Death After a Long Life” by Samuel Harrington, M.D. (I’ll refer to this book simply as “At Peace” in this blog post.)
I am often on the lookout for new books, movies, pamphlets and other tools that might help clients through the estate planning process. Rather than a tool for clients, this book ended up helping me at exactly the time I needed it, even though I didn’t realize I needed it. This particular trip was a few months after my father died, after he had had a short stay in hospice. I didn’t realize it at the time, but I had been doubting myself and the decisions I helped my family make regarding my father’s end of life care and hospitalization. Like many health care agents in the same position, I found myself wondering after he died, “Should we have been more aggressive with his treatments?” “Would he have wanted dialysis?” “Would he be here today if I’d made different choices?” I regularly stop and wonder what he would think about the current stay at home order. He was so active and always wanted to help others. In short, did we do the right thing, and did we (did I) honor what his wishes would have been?
At Peace was such a comfort to me, and helped to quiet those inner voices questioning the decisions around my father’s end of life care. Dr. Harrington provides an authoritative and informative guide to families and individuals for end of life decisions. Although he is a medical expert and provides evidence and technical support throughout much of the book, he also writes from his perspective as a son. He writes as a son who clearly loved his parents and struggled with the same doubt I had at the time I read his book. He describes the decisions he helped his parents make for their health care, addresses his regrets, and shares with us his “lessons learned.”
A big portion of the book is devoted to describing the terminal patterns of the six most common chronic diseases, and how to recognize a terminal diagnosis even if the doctor does not state that a diagnosis is actually terminal. He addresses recommendations for minimizing painful treatments (and acknowledges the tendency in America to overtreat in many instances), and discusses how to approach end of life decisions with loved ones. At Peace also addresses other unique issues for end of life decision making, such as helping a terminal patient who has dementia.
Fundamentally important, of course, is the principal that patients are in control of their own health care, and get to make their own medical decisions as long as they are able. However, perhaps our role in society and as loved ones/family members is to help the patient understand the cost/benefit analysis and resist the urge to always medically treat someone to the maximum extent possible.
One of the best summaries of At Peace is the review by Lucy Kalanithi, M.D. (author of the epilogue of When Breath Becomes Air, by her late husband, Paul Kalanithi): “Well researched, clear-eyed, and brilliantly practical. This is a guide and conversation starter for older Americans seeking control and comfort at the end of life. An antidote to modern overmedicalization that’s both simple and sage.”
When we all feel more comfortable with traveling again, I hope you’ll consider looking for this book in the airport and adding it to your library. I’m very glad I did.
Post by: Vickie R. Wilcox, J.D., LL.M. (Taxation)
Disclaimer: These materials are designed as a general overview and should not be relied upon for legal or tax advice. Please consult a qualified attorney and/or tax advisor for compliance and up-to-date information and advice specific to your circumstances.