ElderWeb

The Family Caregiver Alliance (FCA) has created a fact sheet on end-of-life decision-making. As they state it, "Americans are a people who plan. We plan everything: our schedules, our careers and work projects, our weddings and vacations, our retirements. Many of us plan for the disposal of our estates after we die. The one area that most of us avoid planning is the end of our life. Yet, if we don't plan, if we don't at least think about it and share our ideas with those we love, others take over at the very time when we are most vulnerable, most in need of understanding and comfort, and most longing for dignity. Big issues confront us when we think about our own death or that of someone we love. Our attitudes and beliefs about religion, pain, suffering, loss of consciousness, and leaving behind those we love come into play. We can let things unfold as they may, and for some of us that's exactly right. For others of us, it is good to plan."

>> FCA Fact Sheet

Illinois bill SB 1567 changed provisions of the law relating to powers of attorney. Language was added for situations when an agent is acting for a principal who is incapacitated. The new language says that a principal shall be considered incapacitated if that individual is under a legal disability as defined in Section 11a-2 of the Probate Act of 1975, or if a physician has examined the principal and has determined that the principal lacks decision making capacity, and the physician makes a written record of this determination, signs it within 90 days after the examination, and delivers it to the agent. In that event, the agent may rely conclusively on that written record.

In the event that the principal is incapacitated, the agent must provide a record of all receipts, disbursements, and significant actions taken under the authority of the agency when requested to do so: (i) by a representative of a provider agency, acting in the course of an assessment of a complaint of elder abuse or neglect under that Act; or (ii) by a representative of the Office of the State Long Term Care Ombudsman acting in the course of an investigation of a complaint of financial exploitation of a nursing home resident.

The California legislature has enacted a new law consolidating several previous law related to advanced healthcare directives. Advanced directives are used to allow people to influence decisions about how they will be cared for in the event they become unable to make their wishes known directly.

The new allows people to appoint another person to be their health care "agent." This person, called an "attorney-in-fact", will have legal authority to make decisions about their medical care if they become unable to make these decisions for themselves. The law also allows people to document their health care wishes in the Advance Health Care Directive form, for example, a desire not to receive treatment that only prolongs the dying process in the event of a terminal illness.

The Advance Health Care Directive is now the legally recognized format for a living will in California, replacing the Natural Death Act Declaration. The Advance Health Care Directive is more comprehensive than a living will, which only states a desire not to receive life-sustaining treatment if the person is terminally ill or permanently unconscious. The Advance Health Care Directive can be used to state the person's desires about their health care in any situation in which they are unable to make your own decisions.

The Advance Health Care Directive has also replaced the Durable Power of Attorney for Health Care (or "DPAHC") as the legally recognized document for appointing a health care agent in California. Previously executed Durable Powers of Attorney for Health Care or Natural Death Act Declarations will remain valid unless replaced with the new Advance Health Care Directive.

The Ontario Legislature has enacted numerous changes to the Health Care Consent law, which will become effective in December of 2000.

The Detroit Free Press has published an expose about guardianship in Michigan. Guardians may be appointed by a court for older people who are no longer able to handle their own affairs. In some cases, guardians may be family members, in others they may be people or businesses who are paid to oversee the affairs of the charges. In every case, guardians have complete control over the life and financial affairs of their wards. Even so, there is shockingly little oversight over guardians and the decisions they make. No one audits the financial reports they prepare, and they re not even subject to background checks.

In this article, reporters uncovered instances where court-appointed guardians allowed client homes to be foreclosed on, took possession of a client's property, and charged "commissions" on property sales they arranged. Reporters also found instances were family members were available to oversee their parents affairs, but the court appointed an outsider as guardian without even talking to the family members to see if they would be appropriate.

>> Detroit Free Press Article

Age Concern released a report showing that 50 elderly patients had been labelled "not for resuscitation" (NFR) by doctors without their consent. Age Concern released its list after a 66-year-old cancer patient discovered the comment "inappropriate for resuscitation" was written on her medical notes.

An editorial in the British Medical Journal reported that doctors in Britain do not consult up to two thirds of patients on decisions that could lead to their deaths. Patients listed as NFR were 30 times more likely to die than other patients. Do not resuscitate orders are more commonly used for older people, suggesting that doctors have stereotypes of who is not worth saving.

The Department of Health said it did not plan to investigate whether the claims were widespread, saying doctors and hospitals had clear guidelines on the issue.

The AMA has posted information for patients about advanced directives, such as health care powers of attorney and living wills. They hope to educate consumers about how to clearly convey the patient's wishes for medical care in those situations when they are unable to communicate or become unable mentally to make decisions for themselves.