The Honolulu
Star-Advertiser has featured several stories by reporter Dan Nakaso about
the plight of Karen Okada. Karen is a
95-year-old woman who signed a “Death with Dignity Declaration” and a “Durable
Power of Attorney for Health Care Instructions” back in 1998. Both documents purport to control “in all
circumstances.”
The Queen’s Medical Center has determined that Karen is
essentially brain dead, or, in any event, has “permanently” lost the ability to
participate in medical treatment decisions, and that the provisions of her
Death with Dignity Declaration now require that her feeding tube be withdrawn.
On the other hand, Karen’s health-care agent, in consultation
with doctors who are not associated with Queen’s, disagrees with the
conclusions reached by the Queen’s physicians.
What the agent knows, and the Queen’s physicians discount, is that just
before she was hospitalized at Queen’s, Karen was conscious and able to
interact meaningfully with her family and caregivers. During the time she has been at Queen’s for a
bout with pneumonia, Karen has been unresponsive when doctors have examined
her, but she has smiled at least twice at her adult grandchildren and nodded to
her grandson in response to his question of whether she was able to breathe freely.
The policy of Queen’s is to give precedence to an advance
health-care directive over a durable power of attorney in all events, and
without inquiring into why a person may have signed apparently contradictory
documents. Accordingly, Queen’s sued
Karen’s health-care agent in order to get a court order forcing him to order
that Karen’s feeding tube be removed.
Since no one would want to be part of this kind of drama, what
can you do to make your wishes clearly known so there will be no questions
about how to carry them out?
- If
you do not have an advance-health care directive in place, get one. Make sure your loved ones—including your
children over the age of 18—have advance health-care directives too. - Learn
all you can about the options that can be written into your advance health-care
directive. These are not “one size fits
all” documents. Your wishes may differ
greatly from those of your friends and family members, and the document you
sign should express your particular desires. - If
you have an advance health-care directive that is more than 5 years old, there
is a good chance that it will not accomplish what you think it will. Review it right away with your legal counsel. Make any appropriate changes and updates. - If
you want to give a trusted family member or friend the power to make
health-care decisions for you, make sure the power of attorney meshes well with
any other instructions you may want to provide. - Be
sure to give your health-care providers your permission to give your medical
information to your family members or other trusted decision makers. Federal and State privacy laws can restrict
your doctor from talking with your health-care agent unless you specifically grant
that permission. - Review
your advance health-care directive periodically to make sure it accurately
states your current wishes. Once per
year is not too often. - Make
sure you have a mechanism in place for giving you access to your advance
health-care directive, no matter when or where an emergency might occur. Not all health problems happen in the home,
and if you have a crisis situation while you are travelling, you will need a
way to make your health-care documents accessible to your caregivers. - Talk with your family about your wishes BEFORE a crisis arises. Make sure everybody is on the same page. If your chosen decision makers indicate hesitation about carrying out your wishes, think about naming someone who will. Your assurance to your loved ones of how seriously you intend your instructions to be taken will give them the courage to carry them out.
Knowledge
is power. The more you know about advance health-care directives, and the sooner you act on that knowledge, the more
likely it will be that your wishes will be carried out in the future.