Health Care Directives - Recommended New Yorker Article On Hospice Care: "Letting Go: What Should Medicine Do When It Can't Save Your Life?

One of my favorite physician writers is Atul Gatwande, a practicing physician in Boston. He recently wrote a 15-page article in the New Yorker titled titled "Letting Go: What Should Medicine Do When It Can't Save Your Life?" which focuses on the use and application of hospice care in terminal patients regardless of disease and/or condition.

In creating trusts, drafting estate plans and health care directives, we encourage our clients to think about these end-of-life issues. What would you do if you are hit with news of a terminal illness? How do you think you and your family will react as treatment choices are made or when non-treatment is chosen? How should hospice/palliative care be defined? Do you want to incorporate your wishes on these subjects into your health care directive or estate planning?

If you are given fewer than 90 days to live, do you want to "fight death" as long as possible? It may be impossible to know how you really feel about these issues unless you or another family member have gone through it. This article addresses the fact that medical insurance (including Medicare) does not pay for doctors to have extensive conversations with the family about the options and whether "fighting death" at all costs for a month or longer is worth it and how such a fight could affect the quality of life in those last months.

In our practice, we see that in our society we are often not good at helping people sort out what is most important to them when they are facing a terminal illness and helping them achieve it. This is why advance health care directives have become popular in estate planning.

In our practice, the Advance Health Care Directive identifies the individuals that you desire to act for you if you become unable to make medical decisions for yourself. The most common decision involves when, and under what circumstances, extraordinary measures should be used to prolong life. There are also sections of the Advanced Health Care Directive which deal with whether or not you desire to be an organ donor. This is part of our basic estate plan package.

It is an excellent article and it will help you think about these issues,

Hospice medical care for dying patients: newyorker.com

Posted by Henry (Hank) J. Moravec, III, a partner at Moravec, Varga & Mooney, A Partnership. For a free 30 minute consultation (telephonic or in person), you can e-mail Hank Moravec at hm@moravecslaw.com or call him at (626) 793-3210 or (818) 769-4221.

He focuses his practice on Estate Planning, Trust and Probate Administration, Beneficiary and Trustee Representation, Probate Litigation, Tax Law, and Nonprofit Law. He represents clients throughout Southern California and his offices are conveniently located for clients in the Los Angeles, Santa Barbara, Orange, Riverside and San Bernardino Counties.

With respect to estate planning and probate, Hank Moravec has over 20 years' experience as one of the best Los Angeles estate attorneys and Los Angeles probate attorneys and is available should you need legal advice regarding your own or a family member's situation. For a consultation, You can e-mail Hank Moravec at hm@moravecslaw.com or call him at (626) 793-3210 or (818) 769-4221 to request a consultation.

The firm website is http://www.moravecslaw.com/. The firm has two offices and consultations and meetings can be held at either office.

The San Gabriel Valley office is located at 2233 Huntington Drive, Suite 17, San Marino, California 91108. There is ample free parking adjacent to the firm's office.

The San Fernando Valley office is located at 4605 Lankershim Boulevard, Suite 718, North Hollywood, California 91602-1878.

Advance Health Care Directives: L.A.Times Article On California Program That Helps People Record Wishes At End Of Life

Part of our basic estate plan is helping our clients draft Advance Health Care Directives. The Advance Health Care Directive identifies the individuals that you desire to act for you if you become unable to make medical decisions for yourself.

The most common decision involves when, and under what circumstances, extraordinary measures should be used to prolong life. There are also sections of the Advanced Health Care Directive which deal with whether or not you desire to be an organ donor. This is part of our basic estate plan package.

On July 2, 1010, the Los Angeles Times had an article entitled "California program helps people record wishes at end of life." This article is about a program used in California to help nursing home and terminally ill patients express their wishes regarding treatment at the end of life.

Efforts to increase awareness about the program are being led in California by the Coalition for Compassionate Care of California and the California HealthCare Foundation. Information and opportunities to learn about the program can also be found on this web site.
The program is called Physician Orders for Life-Sustaining Treatment (POLST) and has been adopted in many nursing homes, hospitals and long-term care facilities in California beginning in January, 2009. The program involves an innovative medical form, that is signed by a doctor, allowing patients to specify what kind of care they want at the end of life, such as feeding tubes and other medical interventions. The form was designed 20 years ago in Oregon because of concerns that traditional Do Not Resuscitate orders and advanced directives do not fully communicate patients' wishes for many situations and types of treatments.
POLST forms are different that advanced health care directives. However, advanced health care directives can help your family members complete the POLST forms in the event that you are incapacitated and are evidence of your intentions. Here are sample POLST forms in a variety of languages.
POLST forms address when and if there should be (1) cardiopulmonary resuscitation when the person has no pulse is not breathing or if there should be a DNR [do not resuscitate]; (2) medical interventions when the person has pulse and/or is breathing ranging from only comfort, limited interventions (such as IV or antibiotics) or full treatment (intubation, defribillation, intensive care); and (3) artificially administered nutrition. This form can be modified at any time as long as there is capacity. When there is not capacity, the advance health care directive can demonstrate intent. POLST forms are signed by the physician at the hospital.
In order to prepare for determining your intentions, I would suggest that you read an Advanced Health Care Directive or read the information available on these websites, and think about the following questions:

(1) Who do you want to make health care decisions for you when you can't make them?

(2) What kind of medical treatment do you want or don't want?

(3) How comfortable you want to be?

(4) How do you want people to treat you?

(5) What would you want your loved ones to know about your health condition?

It is an excellent idea for those executing Advance Health Care Directives to speak openly and honestly with the person or persons they designate and go through the different situations that might come up. While no one can anticipate every medical situation, a thoughtful and reasoned discussion can cover the more likely scenarios.

Posted by Henry (Hank) J. Moravec, III, a partner at Moravec, Varga and Mooney. For a complimentary 30 minute consultation (telephonic or in person), you can e-mail Hank Moravec at hm@moravecslaw.com or call him at (626) 793-3210.

He focuses his practice on Estate Planning, Trust and Probate Administration, Beneficiary and Trustee Representation, Probate Litigation, Tax Law, and Nonprofit Law. He represents clients throughout Southern California and his offices are conveniently located for clients in the Los Angeles, Orange, Santa Barbara, Riverside and San Bernardino Counties.

The firm website is http://www.moravecslaw.com/. The firm's office is located at 2233 Huntington Drive, Suite 17, San Marino, California 91108. Telephone: (626) 793-3210.

Advanced Health Care Directive: WSJ Article About "Preparing For The Final Hours"

Lately, there has been a great deal of discussion about health-care reform. The issue of living wills and health care directives has also come up. The August 18, 2009 issue of the Wall Street Journal has an article entitled "Preparing For The Final Hours."

The article notes that less than a third of American adults, and less than half of nursing-home patients, have filled out health care directives. There are a number of reasons for not doing so: (1) lack of understanding of the options or the consequences, (2) lack of understanding of the legalities, and (3) reluctance by people to discuss the subject of death.

The Advance Health Care Directive identifies the individuals that you desire to act for you if you become unable to make medical decisions for yourself. The most common decision involves when, and under what circumstances, extraordinary measures should be used to prolong life. There are also sections of the Advanced Health Care Directive which deal with whether or not you desire to be an organ donor. This is part of our basic estate plan package.

In order to prepare for determining your intentions, I would suggest that you read an Advanced Health Care Directive, and think about the following questions:

(1) Who do you want to make health care decisions for you when you can't make them?

(2) What kind of medical treatment do you want or don't want?

(3) How comfortable you want to be?

(4) How do you want people to treat you?

(5) What would you want your loved ones to know about your health condition?

A written Advanced Health Care Directive by itself does not ensure that your wishes will be understood and respected. Studies have shown that standard advance directive forms do little to influence end-of-life decisions without: (a) informed, thoughtful reflection about your wishes and values, and (b) communication between you and your likely or selected decision-makers before a situation occurs.

It is an excellent idea for those executing Advance Health Care Directives to speak openly and honestly with the person or persons they designate and go through the different situations that might come up. While no one can anticipate every medical situation, a thoughtful and reasoned discussion can cover the more likely scenarios.

The Wall Street Journal article can be found at:
http://online.wsj.com/article/SB10001424052970204044204574356423438598710.html

Posted by Henry Moravec, III. Any questions or comments should be directed to: hm@moravecslaw.com or (626) 793-3210. The firm website is http://www.moravecslaw.com/