Will to Live

How proper planning can impact the quality of your final days
Many of my estate-planning clients grasp the importance
of wills, living trusts and financial powers of attorney
but feel unprepared when the conversation turns
to quality-of-life for their final years.
In the 1970s and again in the 1990s, the nation became
engrossed with end-of-life issues when the media
grabbed hold of the stories of Karen Ann Quinlan and, later,
Terri Schiavo.
Quinlan experienced a brain injury after consuming drugs and
alcohol at a party. Her parents requested the hospital stop active
care when she slipped into a vegetative state for several months
without improvement. The hospital refused, but the courts eventually
allowed removal of the ventilator.
Terri Schiavo’s parents battled for continued life support measures
for almost seven years after their daughter went into cardiac
arrest and suffered massive brain damage due to lack of oxygen.
She was diagnosed as being in a persistent vegetative state, and
eventually the courts ruled in favor of her husband, who argued for
removal of the feeding tube that was keeping her alive.
The Quinlan case gave momentum to “living wills,” and the Schiavo
case highlights the importance of designating the person you
want making care decisions for you if you can’t speak for yourself.
A living will documents what kinds of medical treatments you
would or would not want at the end of life. It is estimated that
nearly 90 percent of us have heard of a living will, and 70
percent of us have thought about end-of-life decisions but
only 25 percent to 30 percent of us have put the appropriate
documentation together.
Living wills are often silent on who you want to be
your health care advocate. In California and most
of the nation, the living will has evolved into
an “advanced health care directive,” which
appoints your health care surrogate and outlines
your end-of-life treatment wishes.
But with continued advances in science and
technology, some of your attempts to articulate treatment
directions will be inadequate, and it could fall to
your agent to translate your preferences and values in
unforeseen circumstances. However, as medical science
has progressed, innovative approaches have evolved to
provide meaningful health care guidance:
The “Five Wishes” living will delves into personal, emotional
and spiritual needs as well as medical wishes. It addresses
(1) choice of health care agents, (2) treatment preferences,
(3) comfort wishes, (4) how you want people to treat you, and
(5) what you want your loved ones to know.
At gowish.org, consumers can fi nd the GoWish game of 40
playing cards that can help you fi nd words to articulate what is
important to you at the end of life. Categorize the cards as very
important, somewhat important or not important, stimulating
meaningful dialogue that can be shared with family, health care
surrogates, doctors and attorneys. Other excellent resources
can be found at the National Healthcare Decision Day website,
The key is selecting a person who is willing to act, listen
and honor your needs, wishes and values, and is able to
make diffi cult choices in crisis. But in addition to having
the person and documents in place, you need to have
the conversations that give context to nuanced decisions
your agent must make when faced with uncertain
medical choices.
David L. Kelly is a certified specialist in estate planning,
trust and probate law. He is a member of the Burton
Law Firm, with offices in Sacramento and Roseville.


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