Who Should Pull the Plug?

All the advance directives were in place.

But I failed her.

She was in a coma after surgery, hooked up to all kinds of tubes and machines – precisely what she didn’t want. I asked her doctor how likely she was to wake up and recover. His exact words were, “Slim. Around 5%.”

I remember thinking: “Who am I to deprive her of a 5% chance of living?”

Here’s what I learned from that experience.

Doctors may not be a reliable source of information

There’s evidence doctors resist conveying the unvarnished truth to terminally ill patients. There are many reasons for this behavior, including not feeling comfortable taking away hope from patients and difficulties handling patients’ reactions to bad news.

One study concluded: “Truth telling in terminally ill patients seems to be one of the most difficult tasks for doctors and other professionals...”

That was my experience with my mom’s doctor.

If he had eliminated hope, I would have honored her wishes.

A conundrum

Traditional advice includes preparing advance directives (like a living will and a durable power of attorney for health care). These documents are critical, but the problem remains: Someone has to make the ultimate decision to terminate life. If that person is a loved one, and the doctor is preserving hope, the patient's wishes may not be honored.

Alternatives

Here are some suggestions for avoiding end-of-life issues:

Advance directives

While medical professionals may be reluctant to act against the wishes of family members, the more precise the advance directives are, the more likely they will be honored.

This article lists situations and interventions to consider in a living will.

Ethics committees

Many healthcare institutions have ethics committees that can provide guidance and recommendations in challenging end-of-life cases. These committees consist of experts in various fields, including medicine, law, and ethics, who can help resolve ethical dilemmas.

Consider providing advance care directives that those making the final decisions will consult with ethics committees. According to the AMA Code of Medical Ethics, the views of these committees should not be binding, but they can serve as a source of reliable, objective advice.

Patients’ rights

Familiarize clients with the rights of patients to control their care.

For example:

• Patients with impaired capacity should still be consulted to “the greatest extent possible.”

• Patients have the right to “decline or halt any medical intervention even when that decision is expected to lead to his or her death.”

• Terminally ill patients in extreme pain may qualify for “sedation to unconsciousness” as an intervention of last resort.

Second opinions

Seeking a second opinion from another medical professional can offer a fresh perspective on the patient's condition and treatment options. This can be especially helpful when loved ones are struggling to accept the advice of the primary care team.

According to the AMA Code of Medical Ethics, you have an absolute right to obtain a second opinion.

State laws vary

End-of-life options can vary from state to state. Some states allow for assisted dying; others do not. Some states have laws regarding the use of advance directives, living wills, and durable powers of attorney for healthcare, while others do not.

Consult with a qualified legal professional in your state to ensure your advance directives comply with applicable laws.

Final thoughts

End-of-life decisions are emotionally charged and challenging. While loved ones undoubtedly have the patient's best interests at heart, their emotional involvement can complicate the decision-making process and potentially lead to choices that may not align with the patient's wishes or best medical interests.

By considering healthcare proxies, advance care planning, consultations with ethics committees, and getting a second opinion, your clients can ensure that their end-of-life decisions are consistent with their wishes.

Dan coaches evidence-based financial advisors on how to convert more prospects into clients. His digital marketing firm is a leading provider of SEO, website design, branding, content marketing, and video production services to financial advisors worldwide.

A message from Advisor Perspectives and VettaFi: To learn more about this and other topics, check out our most recent white papers.

Read more articles by Dan Solin