Critter Corner: What Should I keep in Mind When it Comes to Incapacity Planning?

Dear Hayek,

I am planning on doing my incapacity planning soon.  I always like to plan ahead for everything. What are the varied medical issues and methods of intervention that a person should keep in mind in order to be thoughtful and thorough when doing incapacity planning? 

Thanks for your help!

Planna Head

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Dear Planna,

Incapacity planning is a process through which you create:

1. A General Power of Attorney to name someone to make legal and financial decisions for you if you are unable to due to a temporary or permanent incapacity, and
2. An Advance Medical Directive to name someone to make healthcare decisions for you if you are unable to due to a temporary or permanent incapacity.

Your question is about the Advance Medical Directive, which, when done properly, also allows you to specify your wishes and desired treatment preferences for when you are unable to make decisions on your own.

When considering interventions, some questions to think ahead about include:

• What if my medical condition at the time is irreversible?
• Do I at that time have a non-curable chronic medical condition that will progress to end stage disease? Does my disease impact my ability to function in everyday life, and will functioning deteriorate over time? Will the burden of uncomfortable or even painful symptoms be great?
• What if I was in a coma or a persistent vegetative state?
• Is meaningful recovery possible or unlikely?

Desired interventions will likely differ depending on the answers to the above questions.

Consider the Benefits and Burdens of Intervention

In addition, the benefits and the burdens of the intervention will need to be considered:

Will the intervention under consideration…

• Help me to live longer?
• Improve my quality of life?
• Enable me to do more things?
• Lessen my suffering?

What kind of burdens and side effects will the proposed treatment impose?

These basic questions can be used in discussions with health care providers and family to try to clarify various scenarios that may occur in the future, and decisions you would make should they occur.

Medical Interventions to Consider

Research, talk to family members, and think seriously about the following medical interventions and whether you’d want them. Talk to your doctor if you have questions about any of these medical decisions:

• Cardiopulmonary resuscitation (CPR) restarts the heart when it has stopped beating. Determine if and when you would want to be resuscitated by CPR or by a device that delivers an electric shock to stimulate the heart.
• Mechanical ventilation takes over your breathing if you’re unable to breathe on your own. Consider if, when, and for how long you would want to be placed on a mechanical ventilator. Please read Mr. Farr’s article on the subject for more details on ventilators.
• Tube feeding supplies the body with nutrients and fluids intravenously or via a tube in the stomach. Decide if, when, and for how long you would want to be fed in this manner.
• Dialysis removes waste from your blood and manages fluid levels if your kidneys no longer function. Determine if, when, and for how long you would want to receive this treatment.
• Antibiotics or antiviral medications can be used to treat many infections. If you were near the end of life, would you want an infection to be treated aggressively or would you rather let the infection run its course?
• Comfort care (including palliative care and hospice care) includes any number of interventions that may be used to keep you comfortable and manage pain while abiding by your other treatment wishes. This may include being allowed to die at home, getting pain medications, being fed ice chips to soothe mouth dryness, and avoiding invasive tests or treatments.
• Organ and tissue donations for transplantation can be specified in the after-death directive portion of your Advance Medical Directive. If your organs are removed for donation, you will be kept on life-sustaining treatment temporarily until the procedure is complete. To help your health care agent avoid any confusion, you may want to state in your Advance Medical Directive that you understand the need for this temporary intervention.

Donating your body for scientific study also can be specified. Contact a local medical school, university or donation program for information on how to register for a planned donation for research. There are also services such as the Anatomy Gifts Registry that provide alternatives to traditional final arrangement options, including free or nearly free cremation services. By donating your body to science, individuals can have a lasting way to support medical research advancements that could impact the lives of future generations for decades to come.

Advance Planning is Well Worth the Effort

Although the process of incapacity planning may seem daunting, it is well worth the effort. You will feel more in control of the future and more confident that future decisions will be made in accordance with your wishes. When you have a good Advance Medical Directive in place, a significant burden is lifted from the decision maker and family who are trying to sort through various treatment options for the one they love during an otherwise stressful time. With a good Advance Medical Directive in place, health care professionals caring for you can also feel confident that they are following your wishes.

Hope this is helpful and we hope to see you in the office soon!

Hayek