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The Importance of Planning for Medical and End-of-Life Decisions

Posted Wednesday, September 12, 2018 by Pivotal Law Group

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People make an estate plan because they want certainty about what will happen in the future. This often includes certainty about who will make medical decisions for you if you’re ever unable to do so. For many people, one important future medical decision is so-called “end-of-life” planning. This means exercising control over medical treatment and decision-making in a terminal illness or similar condition. Some people express a desire to go off life support or decline life-sustaining medical care because they don’t want to artificially prolong the process of their dying. Others just want a firm plan for who will make those decisions to give themselves and their family certainty.

People have a right to make end-of-life plans. Medical ethical principles give patients an absolute right to decide what medical treatment to undergo, including the right to refuse medical treatment. That includes designating someone else to decide to refuse medical treatment on your behalf if you’re incapacitated.

But this generates a conflict with health care providers, who always want to do everything they can to keep patients alive as long as possible regardless of the patient’s awareness or quality of life. When decisions are being made that are, quite literally, life-and-death, medical providers want to be certain they are following the patient’s wishes. It doesn’t matter how forceful your wishes are, or how strongly your trusted decision maker advocates for you, if you haven’t planned for these decisions in a way healthcare providers and the law will recognize.

Washington law gives people the right to plan for this as part of their estate plan. You can express your wishes in advance with a Health Care Directive. Washington’s Natural Death Act permits individuals to issue an advance Health Care Directive describing the individual’s desire for medical providers to withhold or withdraw life-sustaining treatment. A Health Care Directive becomes effective only if the person is certified by doctors to be in a “terminal condition” or “permanent unconscious condition.” In such event, the Health Care Directive expresses the person’s desire that their dying not be prolonged by artificially provided nutrition and hydration. The directive has specific formal requirements including being witnessed by two disinterested persons.

Washington law also gives you the right to designate an agent to make health care decisions on your behalf in the event you’re incapacitated through a Power of Attorney. A Power of Attorney is a formal document granting a third party authority to make decisions on your behalf if you cannot do so. A Power of Attorney providing a trusted agent authority to make medical decisions on your behalf under specific circumstances can give you some certainty that future medical decisions, including end-of-life planning, are made in accordance with your wishes.

The tension between end of life planning and health care providers, and the need for a specific and effective medical decision-making plan, were highlighted in a recent high-profile Oregon case where the patient’s husband accused her doctors of ignoring her wishes for medical treatment. There, doctors continued providing artificial nutrition to the patient despite her wishes in her advanced directive, because the doctors believed the patient’s advance directive was not specific enough under the circumstances. Cases such as this one underscore the need for careful advance planning of your future and end-of-life medical wishes.

If you have questions regarding planning for future medical decision-making, contact Attorney McKean J. Evans for a free consultation.