national press has picked up several reports in the Honolulu Star-Advertiser
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.” 

Queen’s Medical Center, where Karen was hospitalized for pneumonia, determined
that Karen was essentially brain dead, or, in any event, had “permanently” lost
the ability to participate in medical treatment decisions, and that the
provisions of her Death with Dignity Declaration required that her feeding tube
be withdrawn.

the other hand, Karen’s health-care agent, in consultation with doctors who are
not associated with Queen’s, disagreed with the conclusions reached by the
Queen’s physicians.  What the agent knew, and the Queen’s physicians
discounted, was 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 was at Queen’s, on the other hand, Karen was for the most part unresponsive
when doctors examined her, but her family reported that she 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.

policy of Queen’s was 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 took the unusual step of suing Karen’s health-care agent in order to
get a court order forcing him to direct Karen’s physicians to remove her feeding

course, no one would want to be part of this kind of drama.  So what can you do to make your wishes
clearly known so there will be no questions about how to carry them out?

  1. 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.
  2. 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.
  3. 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
  4. 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.
  5. 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.
  6. Review your advance health-care
    directive periodically to make sure it accurately states your current
    wishes.  Once per year is not too often.
  7. 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.
  8. 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. 

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.

case you were curious about what happened to Karen, her family was successful
in gaining her release from Queen’s and placing her in a care home.  Since then, Karen has gained 20 pounds and has
regained her ability to interact meaningfully with her family.

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