Lee Drizin: Hi everyone. This is attorney Lee Drizin, and we’re going to talk today about declarations regarding the withdrawal or continuation of life-sustaining treatment found in advance directives. In all durable powers of attorney for healthcare decisions, there is a section that deals with these types of issues. I think that sometimes clients just don’t really spend as much time as they should to think about the implications of these decisions.
We’re going to cover some of the issues regarding the options that are available regarding the withdrawal or continuation of life-sustaining treatment. What is life-sustaining treatment? Well, it’s actually defined in the Nevada Revised Statutes as medical procedures or intervention that, when administered to a patient, serve only to prolong the process of dying. In other words, we’re talking about procedures that keep you alive. The examples include artificial nutrition and hydration for those who are no longer able to swallow.
That’s sometimes a real surprise to people because they think of life-sustaining treatment as a heart-lung machine, but it can be as simple as if you’re no longer able to swallow and you have an IV in your arm to administer fluids and a tube in your gastrointestinal tract to administer nutrients. These are things that are keeping you alive. It also includes medications to stimulate heart functions and also artificial ventilation when patients can’t breathe on their own. These are only just a few of the types of examples of life-sustaining treatment.
When no direction is provided
The problem is that some doctors are reluctant to withhold or withdraw life-sustaining treatment, whether you have an unconscious patient unless the patient has actually left specific instructions to do so. That’s exactly what the durable power of attorney for healthcare decisions is. It’s an advance directive where you get to designate what your desires are with regard to life-sustaining treatment.
What Are Your Options?
The first option that you have is to indicate that you want your life to be prolonged to the greatest extent possible without regard to your condition, the chances you have for survival or recovery, or even the cost. In other words, this is the option for someone who wants to be kept on life-sustaining treatment no matter what. The next two options deal with the withdrawal of life-sustaining treatment but in very limited circumstances. One indicates that if you’re in a coma and the doctors or advanced practice registered nurse reasonably concludes the coma is irreversible, then you want life-sustaining treatment to be discontinued.
The next option is if you have an incurable or terminal condition or illness and no reasonable hope of long-term recovery or survival, then you’re indicating that you want life-sustaining treatment to be no longer used. Now, there is the concern because we talked about the life-sustaining treatment includes what they call “tube feeding,” where you’re receiving nutrients and water because you’re no longer able to swallow.
There’s an option that indicates that, if withholding or withdrawal of artificial nutrition or hydration may result in death by starvation or dehydration, then you want to keep receiving the life-sustaining treatment.
That is obviously because it’s considered a very painful way of dying. However, we generally don’t see many clients that are indicating this option because if they check this option, then they would conceivably continue to be on life-sustaining treatment, and also if they’re at that point, they generally discuss with their family members that look, I don’t want to suffer, and they’re confident that the family members would have them on hospice care, which is the use of medications to alleviate pain and suffering specifically so that they wouldn’t suffer if life-sustaining treatment is withdrawn.
Then, the other end of the spectrum, you have option “E” which indicates that I do not desire treatment to be provided and/or continued if the burdens of the treatment outweigh the expected benefits. Your agent is to consider the relief of suffering, the preservation of restoration of functioning, and the quality as well as the extent of a possible extension of your life. I tell clients that is the broadest one. It’s the quality of life option.
In other words, you don’t have to be terminally ill and you don’t have to be in a coma, but you’re essentially directing your healthcare agent that if I have no quality of life, then I don’t want to stay in this state any longer and you’re authorizing that person to withdraw life-sustaining treatment under those circumstances.
There’s another option that’s been added by the most recent legislation in 2019. Option “F”, that indicates that if I have an incurable or terminal condition, including late-stage dementia or illness and no reasonable hope of long-term recovery or survival, I desire my attending physician to administer any medication to alleviate suffering without regard that the medication is likely to cause addiction or even reduce the extension of my life.
In other words, this one goes one step further and says, “Look, I’m not leaving it to the judgment of my healthcare agent to administer medication. I’m making it very clear that if these circumstances are present, I want to have my doctor administer medication so that I don’t suffer, even if it means that I could become addicted to the medication.”
Those are the issues that you really need to think about, I think, carefully before you execute your durable power of attorney for healthcare. You should discuss with your healthcare agents that you’re nominating in the document because you need to make sure that they understand what your feelings are. But, more importantly, confirm, that they’re comfortable that they would be able to carry out your wishes if these circumstances presented themselves.
Please don’t forget that we have lots of resources about estate planning information at our firm, including our eBooks on divorce, probate, and estate planning guide with lots more information specifically about estate planning. We also have our new video library where you can go on and get more information about durable powers of attorney as well as some of these other topics. Then, most importantly, if you still have questions, you can always simply call us and schedule a consultation. Anyway, I hope that you found this information helpful, and I look forward to speaking with you soon. Take care.