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The "Conversation": Have You Discussed Your End-Of-Life Wishes?


If you are old enough to be reading this, you should discuss end-of-life issues with family members and prepare your own advanced directives. Right now.

A rather unfortunate story hit the news a little while ago. It's the story of Lorraine Bayless and the Glenwood Gardens nursing home.

Spoiler alert: Lorraine fell into cardiac arrest and the facility was utterly unable to administer CPR, despite the pleading 911 operator. Why? "Company policy."

This matter has been taken up by Forbes in two recent articles, by two different authors. The first, by Howard Gleckman, is titled "The CPR Death At Glenwood Gardens: What Really Happened And Five Lessons You Should Learn." The second Forbes article is penned by Carolyn Rosenblatt and is titled "Nurse Refuses To Give CPR, Senior Dies: Ethical Problem Or Legal Issue?"

Here are four key facts regarding this story. First, Lorraine was having a stroke and CPR was not likely to help her. Second, the "nursing facility" was actually an independent living facility without skilled nurses. Third, Lorraine herself had not wanted a long drawn out passing; and fourth, Lorraine and her family already had arranged for a Do Not Resuscitate (DNR) order.

Against this backdrop, each of us needs to know two fundamental wishes when it comes to our loved ones:

1) What does your loved one want and need in a facility? Since the facility in question was not an actual nursing home and the "nurse" was not actually a skilled nurse, the staff was not allowed to perform CPR, both by "company policy" and by law. There are many types of facilities with varying degrees of medical or personal care. Truly, to be in the "wrong" facility may mean not limiting the care your loved one may want.

2) Likewise, what does your loved one want (or not want) when it comes to end-of-life measures? What decisions has your loved one made regarding emergency care, resuscitation, breathing or other life-sustaining apparatuses? Lorraine purposefully had a DNR, had made her decision, and her family clearly knew her wishes. Nevertheless, there are many additional considerations when it comes to making and communicating your wishes.

As you might imagine, it's best for your senior loved ones to commit their wishes and decisions to writing. The most common form is known by many different names, but is simply a written record of their healthcare directives made in advance. As with financial matters, your senior loved ones also will want to sign a durable power of attorney for medical matters and appoint the "agents" they know and trust to carry out their wishes. Another document to evaluate is the Physician's Orders for Life Sustaining Treatment (POLST), often also called Medical Orders for Life Sustaining Treatment (MOLST).

Regardless, the object of these kinds of documents is to empower your senior loved ones to inform their loved ones, doctors and medical facilities about their wishes now so those wishes can (and will) be carried out later. Note: Once executed, copies of the health care directives should be liberally distributed among agents, non-agent family members, doctors and medical facilities. As these end-of-life wishes also are emotional decisions, it is best if everyone concerned is informed rather than surprised.

This end-of-life planning isn't just for senior loved ones. Have you made your wishes known through proper legal planning? The best way to encourage personal responsibility in others is to lead by example.

For more information, please visit my estate planning website.

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