Advance Health Care Directives: How Can Planning Ahead Avoid Family Conflicts?

Did you know that April 16 is National Health Care Decisions Day, intended to educate and empower the public and healthcare providers to take part in important advance care planning? ?If you don’t have an advance directive, medical personnel rely on your family members to determine what your wishes may be if you temporarily or permanently can’t make medical decisions for yourself. Loved ones often struggle to make these difficult decisions, especially in a time of crisis. And if they disagree about what you would have wanted, important treatments may even be delayed.

As an Elder Care Mediator, I frequently am approached by families seeking help when they are in conflict about what care would be best for their parents or grandparents. However, if their Elder has a valid Advance Health Care Directive, we at least have a starting point for discussions about what should be done and who should ultimately make the decisions.

Unfortunately, timely advance planning doesn’t always avoid conflict. For example, instructions about what treatments are desired and what treatments should be avoided can leave room for interpretation. That’s why it is important to express your wishes as clearly as possible in a legally binding document. Also, assigning multiple people as medical proxies (also called Powers of Attorney for Health Care) can lead to conflicts when they don’t agree on the desired treatment. That’s why it’s best to assign a primary and secondary (and sometimes even 3rd) proxy and to make sure those individuals are willing and able to make decisions according to your wishes, as opposed to what they believe would be best for you.

In my recent practice, I’ve worked with several families who had disagreements about the actions of a health care proxy. In most cases, the siblings or children of an aging loved on who did not have Powers of Attorney for Health care were upset about the decisions of the person who had that power. Long standing tensions between siblings or stepparents and adult stepchildren can erupt anew when their loved one is facing a medical crisis. In most cases, coming together for a facilitated family meeting or mediation session can help everyone feel heard and included in the decision-making process, allowing other family members to understand and support the difficult decisions of the health care proxy.

Unfortunately, I’ve experienced two scenarios where I wasn’t able to support an amicable outcome:

1) When a stepmom with Powers of Attorney for her husband thought that the time had come to honor his wishes by turning off his life support, she asked me to facilitate a family meeting with his adult children from a previous marriage, to include them in and prepare them for the difficult decision she was facing. While their honest and open discussions helped most of the children to understand and accept their stepmom’s decision, one of them could not go along with it. Nevertheless, the stepmom was glad that she had gone through the facilitated family meeting/mediation process, which gave her more clarity and peace of mind to implement the wishes her husband had outlined very clearly in his Advance Health Care Directive.

2) More recently, a woman asked me for help, because her sister was interfering with the care decisions she was making for their dad, who had recently been diagnosed with mid-stage dementia. Although her dad had assigned her as his medical proxy, he did so in front of a Notary, not an Estate Planning attorney, only two weeks before he received his dementia diagnosis. Under these circumstances, I was concerned that the sister may contest the validity of her dad’s advance health care directive and referred the potential client to an Elder Law attorney instead. The situation reminded me once again how important it is for people of any age to fill in and execute a valid Advance Health Care Directive, rather than waiting until they may lose the capacity to do so.?

Are you or a friend, colleague or client concerned, because aging loved ones don’t have an Advance Health Care Directive and are resistant to talk about it? Please, ask them to call or text me at 510-356-7830 or e-mail [email protected], so I can offer them a complimentary confidential consultation to explore how I can help bring their family together for a Facilitated Meeting to discuss the difficult topic of advance planning and support peace of mind for everyone involved. ??

Katharina W. Dress, M.A., Mediator / Facilitator / Conflict Coach

AGING IN HARMONY, Cell Phone: 510-356-7830

E-Mail: [email protected] , Web: www.aginginharmony.com

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