The Honolulu Star-Advertiser has featured several stories about Karen
Okada, 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

In mid-2012, shortly after
Karen was admitted to The Queen’s Medical Center for treatment for pneumonia,
the doctors at Queen’s determined that Karen was essentially brain dead, or, in
any event, had “permanently” lost the ability to participate in medical
treatment decisions.  Accordingly,
Queen’s wanted to enforce the provisions of her Death with Dignity Declaration and
withdraw the feeding tube that had been surgically placed in Karen’s side more
than six months before she was admitted to Queen’s.

On the other hand, Karen’s
health-care agent (her brother), in consultation with doctors who are not
associated with Queen’s, disagreed with the conclusions reached by the Queen’s
physicians.  What Karen’s agent knew, and
the Queen’s physicians did not find relevant, was that shortly before she came
down with pneumonia, Karen was conscious and able to interact meaningfully with
her family and caregivers.  During the
time she was at Queen’s, Karen was unresponsive when doctors examined her, but she
reportedly smiled at least twice at her adult grandchildren and nodded to her
grandson when he asked her whether she was able to breathe freely. 

Although Karen breathes on
her own, she has to do so through a tube that was inserted into her
windpipe.  At some point in time, her
family hopes the tube can be removed, which will enable Karen to eat
normally.  In the meantime, Karen has to
be fed through a tube that goes through her side and into her stomach.

Because Queen’s policy is to
give precedence to an advance health-care directive over a durable power of
attorney in all events, and because Queen’s believed that the terms of the
directive required removal of Karen’s feeding tube, Queen’s sued Karen’s brother
in order to get a court to order that Karen’s feeding tube be removed.

Delays in the court process
ultimately caused Queen’s to relent and to allow Karen to be placed in another
facility with her feeding tube intact. 
As subsequently reported in the Star-Advertiser,
Karen’s condition has improved to the point where she can once again interact
meaningfully with her family members and caregivers.

In the meantime, Karen and
her family experienced a drama that no one would want to repeat.  So what are some steps that you can take to spare
yourself and your family from being the characters in a similar story?

If you do not have an advance health-care
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
—at least once per year—to make sure it accurately states your
current wishes.

Make sure you have a mechanism in place for
giving you access
to your advance health-care directive.  You never know 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 else 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.

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