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End-of-life decision-making not always easy, even with preparation

Decision-making for those nearing the end of their life can be a trying time for families. In addition to the personal dynamics involved, there can be a lot at stake financially when somebody dies. When this happens,

Last week, Paul G. Smith, a retired attorney staying at an Indianapolis hospital was pulled off life support after his daughter and medical decision-maker, Judith Sly, gave the order. Smith was reportedly hospitalized in December with dehydration, and his condition quickly suffered, forcing a decision about whether he should continue with a feeding tube and ventilator.

The decision to pull the plug was vehemently opposed by Smith’s daughter Susan Rissman, and created an even stronger division in the family than was already there. Rissman had been her father’s primary caregiver for the past several years and was opposed to stopping an active treatment regimen for him. She felt that any decision should have been left up to Smith as he was able to talk and answer question.

Sly, though, had been given authority over Smith’s care and legal affairs, and she continued in that role despite efforts by Smith’s attorney to name Rissman her father’s legal guardian. Sly’s decision was reportedly supported by another sister and a brother.

Behind the tension was a significant estate including investments and a home valued at $241,000, but larger issues were at stake, including the importance of keeping health care plans up-to-date.

Conflict, of course, is not uncommon in such situations. An advance directive can be helpful, but even these don’t always create the kind of clarity needed to make end-of-life decisions calmly and confidently.

The best way to avoid such situations is to be as prepared as possible. This includes filling out the necessary forms to alert providers to one’s medical preferences. If a medical decision-maker is appointed, the decision should be made wisely. The person should be collaborative, but should also understand your wishes well. It should be a person who you can trust, but who also knows how to work with the family. Another important thing to do is to have conversations with family about one’s preferences, so that there are no surprises.

Doing these things will not necessarily prevent all conflict, but can help greatly to reduce it.

Source: USA Today, “Ind. End-of-life case spotlights difficult decisions,” Tim Evans and Alex Campbell, January 13, 2013