Making End of Life Decisions Part of your Estate Plan

End of life decisions are an important part of your estate plan.

If your end of life decisions are important to you, there are a handful of documents that are typically created during the process of developing an estate plan that can be used to achieve this goal, says the article “Choosing a natural end” from The Dallas Morning News.

The four documents are the Medical Power of Attorney, the Directive to Physicians, the Out-of-Hospital Do-Not-Resuscitate, and the In-Hospital Do-Not-Resuscitate. Note that every state has slightly different estate planning laws. Therefore, you will want to speak with an experienced estate planning attorney in your state. If you spend a lot of time in another state, you may need to have a duplicate set of documents created. Your estate planning attorney will be able to help.  In Texas, attorneys often prepare the Medical Power of Attorney and Directive to Physicians, and Do-Not-Resuscitate Orders are prepared by medical systems.  See Mary’s excellent blog for further background https://galligan-law.com/living-wills-and-medical-powers-of-attorney-why-they-are-important/.

For the Medical Power of Attorney, you are appointing an agent to make health care decisions if you cannot. This may include turning off any life-support systems, refusing life-sustaining treatment and other end of life decisions. Talk with the person you want to take on this role and make sure they understand your wishes and are willing and able to carry them out.  You have the right to change your agent at any time.

The Directive to Physicians, which is basically the Living Will of Texas, is a way for you to let physicians know what you want for comfort care and any life-sustaining treatment in the event you receive a diagnosis of a terminal or irreversible health condition. You aren’t required to have this, but it is a good way to convey your wishes. The directive does not always have to be the one created by the facility where you are being treated, and it may be customized to your wishes, as long as they are within the bounds of law. Many people will execute a basic directive with their estate planning documents, and then have a more detailed directive created when they have a health crisis.  It and the Medical Power of Attorney serve to nominate and provide guidance to your healthcare decision-maker on end of life decisions.

The Do-Not-Resuscitate (DNR) forms come in two different forms in most states. Unlike the Directive to Physicians, the DNR must be signed by your attending physician. The Out-of-Hospital DNR is a legally binding order that documents your wishes to health care professionals acting outside of a hospital setting not to initiate or continue CPR, advanced airway management, artificial ventilation, defibrillation or transcutaneous cardiac pacing. You need to sign this form, but if you are not competent to do so, a proxy or health care agent can sign it.

The In-Hospital DNR instructs a health care professional not to attempt CPR, if your breathing or heart stops. It is issued in a health care facility or hospital and does not require your signature. However, the physician does have to inform you or make a good faith effort to inform a proxy or agent of the order.

If you have specific wishes for your end of life decisions, especially if you want a natural end, speak with your estate planning attorney about how to legally prepare to protect your wishes.

Reference: The Dallas Morning News (Jan. 12, 2020) “Choosing a natural end”

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Funeral Planning: Not a Festive Thought, But A Kind One

Funeral planning as part of your estate plan provides clear, final wishes, names a person to execute them and helps your family cope at a difficult time.

No one wants to do funeral planning, but leaving instructions for your funeral and burial wishes relieves loved ones of the burden of making decisions and hoping they are following your wishes. In addition, says the article “Important to provide instructions for preferred funeral, burial wishes” from The Leader, it also prevents arguments between relatives and friends who have their own opinions about what they think you may have wanted.

What often happens is that people make their funeral plan and final wishes part of their estate plan.  In some states, burial wishes are found in a will.  However, this often presents a problem as the will is usually not looked at until after the funeral. If your loved ones don’t know where your will is, then they certainly won’t know what your wishes were for the funeral.  Without clear written directions, spiritual practices or cultural traditions that are important to you, may not be followed.

An estate planning attorney can help you create a document that outlines your wishes and will have suggestions for how to discuss this with your family and where it should be located.  In Texas, much like in New York as referenced in the article, there is a form that allows you to name an agent who will be in charge of your remains.  In Texas it is called the Appointment for Disposition of Remains.  You can give your instructions to that person in the document which takes the mystery and a lot of the difficulty out of the process.

In Texas, if you don’t name a person to control the disposition of remains, there is an order of priority for decision makers, including spouses, a child, a parent and so on.  If you wouldn’t want those individuals making these decisions, an Appointment for Disposition of Remains is essential.

For funeral planning, one option is to go to the funeral home and arrange to pay for the funeral and go to the cemetery and purchase a plot. In Texas, a pre-need, pre-paid irrevocable burial plan may also be excluded from Medicaid for long-term care purposes.  See here for more on that topic.  https://galligan-law.com/elder-law-questions/

Some people wish to donate their organs, which can be done on a driver’s license or in another statement. This should also be authorized on you Medical Power of Attorney so that your agent has the authority to do so.  Donating your body for medical research or education will require researching medical schools or other institutions and may require an application and other paperwork that confirms your intent to donate your body. When you pass, your family member or whoever is in charge will need to contact the organization and arrange for transport of your remains.

A comprehensive estate plan does more than distribute assets at death. It also includes what a person’s wishes are for their funeral and burial wishes. Think of it as a gift to loved ones.

Reference: The Leader (December 7, 2019) “Important to provide instructions for preferred funeral, burial wishes”

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Living Wills and Medical Powers of Attorney – Why They Are Important

Medical Power of Attorney agent discussed health care decisions with family member
It is important to discuss medical preferences with your medical power of attorney agent.

Living Wills (referred to in Texas as “Directives to Physicians and Family Members”) and Medical Powers of Attorney are important if a person becomes incapacitated, whether that status is permanent or temporary. These are part of a comprehensive estate plan, and you’ll want to take care of this before a medical emergency arises. That’s the recommendation from the McPherson Sentinel article “Advance health care directives important to all adults.”

Documenting your wishes about future health care lets a cognitively healthy person express his or her wishes with a clear perspective. Unfortunately, only one in four American adults has their medical power of attorney and/or living will in place. Many wait to begin the planning process until they are in their 50s or 60s. The problem is, life doesn’t have a plan. Tragedy can strike at any time in life. A serious illness or an accident can occur leaving the family wondering what the person would have wanted.

You do not need to be in an “end of life” situation for a medical power of attorney to come into play. The agent you name in your medical power of attorney makes a health care decision for you any time you cannot communicate your wishes, yourself. This could happen during a routine medical procedure that is not life threatening.

The living will, on the other hand, sets out your wishes in the event you have a terminal condition, death is imminent, and you do no want your life to be prolonged by artificial means. Artificial means may include, among other things,  being placed on a ventilator or receiving artificial nutrition and hydration.

Under Texas law, your agent under a medical power of attorney may make the decision to withhold or withdraw life support, unless you have limited that power in the document. That is why a living will or a directive to physicians may not be legally necessary, if you have named an agent in a medical power of attorney. But many people opt to have a living will in addition to a medical power of attorney. They would like to give their own instructions for end of life decisions as opposed to putting the burden on the agent named in the medical power of attorney.

One thing to keep in mind is that a medical power of attorney is different from a financial durable power of attorney (in Texas – the Statutory Durable Power of Attorney), which gives a person the right to act as another person’s agent and conduct business and financial matters on his or her behalf.

It’s very important that the people you designate as agents in a medical power of attorney or living will are told that they have been named. You should designate an initial agent and then one or more successor agents in case the first person named is unable to act. Your agents need to fully understand what your wishes are and what kinds of treatments are acceptable to you. Communication is the key and you need to make sure that you and your agent have discussed your preferences.

The people you select as agents under your medical power of attorney should also understand that health care decisions for you need to be made according to your wishes and not their wishes or the wishes of other family members.

These documents should be prepared for you as part of your overall estate plan, with the guidance of an estate planning attorney. Be aware that the laws vary from state to state, so you’ll want to work with an attorney who knows your state’s laws. If you relocate to another state, you should update your medical power of attorney and living will to conform with that state’s laws.

Finally, make sure that your medical power of attorney and living will are located in a place where they can be easily found in an emergency.  Your agents should each have a copy they can bring to the hospital, if necessary. The important thing is that the medical power of attorney and living will can be found and used in a time of crisis.

Reference: McPherson Sentinel (April 17, 2019) “Advance health care directives important to all adults”

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