Are Your Final Wishes Made Clear?

Submitted by SadInAmerica on Tue, 05/06/2008 - 10:48am.

When my grandfather was diagnosed with pancreatic cancer last year, his health deteriorated far more quickly than expected. Fortunately, he had left very clear instructions about his wishes for care. ~ Tara Parker-Pope

Or so we thought. As he lay unconscious, my father and his two brothers began debating the deeper meanings of the words he chose in writing his medical directive.

I was reminded of this today while reading a column by my former Wall Street Journal colleague Terri Cullen, who writes about the hidden complications of living wills in her Fiscally Fit column. She provides a rundown of the estate planning documents involved in the process, and also highlights her own family situation. A living will written by her mother seemed clear enough, but it rekindled a long-simmering family conflict.

"Often when it comes to estate planning parents forget that when emotions are involved, even signed legal documents can be open to interpretation,'' she writes.

In the case of my grandfather, he was very clear that he believed every possible effort should be made to save any life, and he supported the use of advanced life-support techniques to keep him alive. However, he also instructed his family to stop advanced life support in the event of a terminal prognosis.

What had once seemed clear was now murky. The pancreatic cancer would certainly kill him, but maybe not for months. Other health problems had put him in the hospital. Would he want treatment to continue?

The doctors were frustrated by my family's indecision and were forced at one point to "call a code" to revive him as his family dissected the language of my grandfather's instructions. In a final bit of irony, his sons, who had finally agreed that a "do not resuscitate" order was appropriate, were still debating other end-of-life issues when the telltale beeping of the hospital monitors began to slow. Everyone stopped talking and stood around the bed, and within seconds, he slipped away. My grandfather had made the decision for us.

But the experience made me realize that having a living will isn't enough — we need to be sure that we have been clear and specific, and that we have considered a variety of scenarios as we try to instruct our loved ones to make decisions for us in a medical crisis. Phrases like "terminal illness" are vague at a time when new treatments and drugs can keep patients with a terminal disease alive for months or years.

To read the full Wall Street Journal column click here. And the Mayo Clinic Web site offers specific details about conversations you should have with your family about things like dialysis and nutrition and hydration assistance as you are crafting your medical directive and discussing end-of-life issues with your family.

Tara Parker-Pope - May 1, 2008 - posted at

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Submitted by SadInAmerica on Tue, 05/06/2008 - 10:48am.


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