The Honolulu Star-Advertiser has featured several stories about Karen Okada, a 95-year-old woman who signed a “Death with Dignity Declaration” and a “Durable Power of Attorney for Health Care Instructions” back in 1998. Both documents purport to control “in all circumstances.”
In mid-2012, shortly after Karen was admitted to The Queen’s Medical Center for treatment for pneumonia, the doctors at Queen’s determined that Karen was essentially brain dead, or, in any event, had “permanently” lost the ability to participate in medical treatment decisions. Accordingly, Queen’s wanted to enforce the provisions of her Death with Dignity Declaration and withdraw the feeding tube that had been surgically placed in Karen’s side more than six months before she was admitted to Queen’s.
On the other hand, Karen’s health-care agent (her brother), in consultation with doctors who are not associated with Queen’s, disagreed with the conclusions reached by the Queen’s physicians. What Karen’s agent knew, and the Queen’s physicians did not find relevant, was that shortly before she came down with pneumonia, Karen was conscious and able to interact meaningfully with her family and caregivers. During the time she was at Queen’s, Karen was unresponsive when doctors examined her, but she reportedly smiled at least twice at her adult grandchildren and nodded to her grandson when he asked her whether she was able to breathe freely.
Although Karen breathes on her own, she has to do so through a tube that was inserted into her windpipe. At some point in time, her family hopes the tube can be removed, which will enable Karen to eat normally. In the meantime, Karen has to be fed through a tube that goes through her side and into her stomach.
Because Queen’s policy is to give precedence to an advance health-care directive over a durable power of attorney in all events, and because Queen’s believed that the terms of the directive required removal of Karen’s feeding tube, Queen’s sued Karen’s brother in order to get a court to order that Karen’s feeding tube be removed.
Delays in the court process ultimately caused Queen’s to relent and to allow Karen to be placed in another facility with her feeding tube intact. As subsequently reported in the Star-Advertiser, Karen’s condition has improved to the point where she can once again interact meaningfully with her family members and caregivers.
In the meantime, Karen and her family experienced a drama that no one would want to repeat. So what are some steps that you can take to spare yourself and your family from being the characters in a similar story?
If you do not have an advance health-care directive in place, get one. Make sure your loved ones—including your children over the age of 18—have advance health-care directives too.
Learn all you can about the options that can be written into your advance health-care directive. These are not “one size fits all” documents. Your wishes may differ greatly from those of your friends and family members, and the document you sign should express your particular desires.
If you have an advance health-care directive that is more than 5 years old, there is a good chance that it will not accomplish what you think it will. Review it right away with your legal counsel. Make any appropriate changes and updates.
If you want to give a trusted family member or friend the power to make health-care decisions for you, make sure the power of attorney meshes well with any other instructions you may want to provide.
Be sure to give your health-care providers your permission to give your medical information to your family members or other trusted decision makers. Federal and State privacy laws can restrict your doctor from talking with your health-care agent unless you specifically grant that permission.
Review your advance health-care directive periodically—at least once per year—to make sure it accurately states your current wishes.
Make sure you have a mechanism in place for giving you access to your advance health-care directive. You never know when or where an emergency might occur. Not all health problems happen in the home, and if you have a crisis situation while you are travelling, you will need a way to make your health-care documents accessible to your caregivers.
Talk with your family about your wishes BEFORE a crisis arises. Make sure everybody is on the same page. If your chosen decision makers indicate hesitation about carrying out your wishes, think about naming someone else who will. Your assurance to your loved ones of how seriously you intend your instructions to be taken will give them the courage to carry them out.
Knowledge is power. The more you know about advance health-care directives, and the sooner you act on that knowledge, the more likely it will be that your wishes will be carried out in the future.