The Difficulty of Life-or-Death Decisions

Posted by Harvey L. CoxSep 24, 20210 Comments

During my initial consultation with clients, I always discuss the various documents that should be part of a comprehensive estate plan. As I explain the purpose of each document, I find that the Directive to Physicians, also known as a Living Will, generates the most discussion. It's also the document clients have the most difficulty signing.

This document creates such a "flurry" of discussion because it forces you to consider that one day you may be hospitalized in an unconscious state with no hope of recovery. And, it puts you in the position to decide how and when to end your life before that happens. Thinking about issues like this can and should make you think deeply and ask a lot of questions.

What Are Your End Of Life Wishes?

Most people will agree that they don't want artificial means to keep them alive if they have a severe brain injury and won't live a meaningful life. But, in reality, the circumstances are not always clearly black and white. Let me use two examples that illustrate the complexities of the issues.

The Case of Shellie Eldredge

The first case scenario involves Shellie Eldredge, a young mother who slipped into a coma after a moped accident in Hawaii broke nearly 50 of her bones, fractured her skull, snapped her spine, and left her in a coma. Her doctors didn't expect her to recover.  They recommended stopping life support. Her husband, however, chose not to follow the recommendation. That turned out to be a great decision. After about a month in the hospital, Shelli recovered enough to go home.

The Case of Edwarda O'Bara

Shelli Eldredge was fortunate. Many people with severe brain injuries and in a coma never recover. Edwarda O'Bara is an example. She slipped into a diabetic-related coma when she was only 16 years old. Her parents cared for her in their home, feeding her through a tube until they died. After their deaths, her sister took over caring for her. She lived for 42 years in a coma and then died.

Using a Directive to Physicians to Communicate Your Wishes

The Directive to Physician allows you to state your preferences with regards to life-sustaining treatment. In it, you say whether you want your doctors to give, withhold or withdraw life-sustaining treatment if you are diagnosed with a terminal or irreversible condition and cannot make your own health care decisions.

You get to decide, in advance, whether you want doctors to withhold all treatment other than that required to keep you comfortable or whether you want to be kept alive in your condition using available life-sustaining treatment.

Terminal and Irreversible Conditions

The Directive to Physicians allows you to state your preferences in two situations. The first situation addresses what you want to happen if you are diagnosed with a terminal condition. The second situation addresses what you want to happen if you are diagnosed with an irreversible condition.

A terminal condition is an incurable condition that will produce death within six months even if you receive life-sustaining treatment.

An irreversible condition is a medical condition that:

  1. May be treated but never cured or eliminated;
  2. Leaves a person unable to care for or make decisions for himself; and
  3. Is fatal without life-sustaining treatment.

The critical thing to remember about the Directive is that it only becomes effective if you become incapacitated and are unable to make these decisions for yourself. And, you can revoke the Directive at any time, even if you are incapacitated, as long as you can communicate your wishes in some way.

Why Sign a Directive?

Signing a Directive is a difficult decision, but it puts you in control of your end-of-life treatment by allowing you to specify in advance what life-sustaining treatment you will receive.

Consider Edwarda Obara's story previously mentioned. I wouldn't want to live like that, would you? But, I wouldn't want my family to end my treatment too soon either. I want my family to give me every possible chance to recover like Shelli Eldredge's family did for her. But, if my condition is such that I will never be able to live a meaningful life, I know in advance that I don't want to be kept alive artificially in a state of unconsciousness for decades. This is especially true in light of recent studies suggesting that some people living in vegetative states are conscious. Can you imagine being conscious but trapped in a body that can't move or communicate for a lifetime?

Signing a Directive to Physicians relieves your family of the burden of making that choice on their own. Should your family disagree about how to proceed, having a directive from you can prevent family conflict.

Making your Decision

Deciding the time and circumstances for withdrawing or withholding life-sustaining treatment is a deeply personal one. It deserves serious thought and consideration. I recommend that you talk to people you trust before making such a decision. I specifically suggest you seek counsel from family members, physicians, and clergy.

But, remember that the Directive is not written in stone. If you change your mind about any aspect of it, you can revoke it entirely or revoke it and sign a new one that is more in line with your latest wishes.

Resources for More Information    

For more information to help you prepare an estate plan, download my books. If you prefer physical copies of the books, call my office at (254) 233-7300, and my staff will get copies to you in the mail.    

I present an estate planning webinar several days a week. You can register for it here.