Chapter 24: Delegating Decisions
Advance Directives

A sudden stroke has left you unable to move, unable to speak – but in constant pain. You can see and hear, though, and you understand that your condition is probably irreversible, and there’s a good chance that you’ll die soon. What you see now is your partner and children gathered around your hospital bed, asking each other and your doctor, “What would she want us to do?” You’re unable to tell them.

Most of us think of estate planning as something that really doesn’t bear fruit until we’re dead. But technology has changed all that. Modern medicine can now keep alive indefinitely many people who would have died a few years ago. Alive, but not necessarily able to take care of themselves. Nowadays, a good estate plan must take into account the possibility that you may someday be unable to care for yourself, make decisions, or even regain consciousness--but remain alive.

You may remember the Nancy Cruzan case, in which a Missouri woman injured in an auto accident suffered a head injury that rendered her unlikely to ever escape from an unresponsive, coma-like state. She had left no written instructions about what doctors were to do if she ever became so disabled. Her family wanted to discontinue intravenous feeding, but the hospital--and the state--refused to allow it. Finally, the U.S. Supreme Court ruled that although individuals do have the right to refuse medical treatment, they must express their wishes clearly enough to meet the standards set by the state in which they live.

The case of Jack Kevorkian, the Michigan doctor who assists people in committing suicides, indicates just how touchy and ambivalent our society remains about euthanasia (mercy killing) and the right to die.

Let’s hope that you never have to face the choices that the Cruzan family and Kevorkian’s patients faced. But there are more common and less spectacular cases in which you may have to let someone else make important decisions for you because you aren’t able to do so.

Twenty years ago, half of Americans died in institutions such as hospitals or nursing homes; today, it’s almost four out of five. The medical personnel in these institutions will look to you for instruction on whether to revive you or resuscitate you. If such procedures would only mean great pain for you and prolonged anguish for your family, or would leave you in a vegetative state, you might not want them performed. But you might not be in condition to refuse them. Or you may be in a situation where you want to live, but can’t manage your affairs.