Kept alive on a ventilator.

The coronavirus COVID-19 has many of us talking about the availability of ventilators like never before. Would you want to be kept alive on a ventilator? If so, would you instruct your family to keep you on it for a week? A month? Longer? Who would you empower to make the decision during a time when you would be unable to communicate for yourself? 

Unlike many other species throughout nature, human beings begin life dependent upon others for survival. It is normally the mother who provides for her newborn baby. A 24/7 care must be provided. Without it, the infant will die. Simple daily activities: bathing, eating, diaper changes, getting dressed, moving from point A to point B are a few of the routine items that an infant child requires. Such is often the case at end of life, too. We may lose our capabilities in reverse order to the sequence in which we first learned them.

During a lasting illness and into the final days, when a person is dying, there is an intense dependency on others for even the most basic events. There can be many similarities in the way we may need to help our youngest and most elderly family members. As children learn to eat on their own, walk, and figure out the potty -training routine, these independent life -skills may be lost as we age. Accidents, injuries, and illnesses may contribute to the reasons why we may need assistance with activities of daily living as juveniles and adults. Substantial help or supervision with these tasks is not only needed by infants!

Remember the story about Terri Schiavo in Florida? She worked as an insurance clerk. She reportedly collapsed in her home in February of 1990, suffered massive brain damage due to lack of oxygen, and was in a coma for over two months before her diagnosis was changed to “persistent vegetative state”. In 1998, Terri’s husband petitioned the court to discontinue life-prolonging measures. Legal challenges from Terri’s parents caused a seven- year delay before her feeding tube was ultimately removed. Her life ended in 2005 at the age of 41. Both her husband and her parents have been involved in activism. The story is compelling to motivate us to get our medical directive, “living will,” and power of attorney documents in -place. Most people have good intentions but rarely get around to it. Make a promise to yourself and set a date on the calendar. As Yoda from Star Wars said, “Do. Or do not. There is no try.” Get something written down. If you change your mind later, then change your documents. Nothing is set in stone and having something in writing may be extremely significant to those you love and those who love you. This is one of those things that you either have in place or you don’t.

There are a number of resources available for a do-it-yourselfer; however, it is relatively easy to make a mistake. A mistake my not be apparent right away and could have severe, unintended consequences in the future. I recommend hiring competent counsel. A discussion with an older family member may be uncomfortable for both of you. Sensitivity and openness are important. When your heart is in the right place, you’ll know it, and so will they. Be supportive by taking the time to listen and by helping your aging relative connect with professional counselors in their community.

We are here to help others, but before we can help others, we must help ourselves. First Timothy 4:16 says, “Take heed unto thyself, and unto the doctrine, continue in them: for so doing this thou shalt both save thyself, and them that hear thee.” There are some projects in life that you can start and stop if need be. Take an important step now, but do not feel as though you must answer every question at one time. Take bite- size pieces! It is estimated that nearly one- half of adults in their 40’s and 50’s have at least one living parent over the age of 65 and have financial responsibilities of support for a child of their own. You are, certainly, in good company.

On airplanes, passengers are instructed to put the oxygen mask on themselves before attempting to help others. There is a good reason for that. Without oxygen, you will pass out and die. The message here is to take care of your own health and finances before attempting to help others. It is not to say you should be greedy and completely self- centered. It is, indeed, honorable to help others and you should once you are in a position to do so. Please don’t take the message the wrong way. Just be certain that you are going to be able to continue to provide for your needs, then give responsibly and sustainably. Create a will if you don’t have one. A valid will may save your heirs from some expensive headaches linked to probate and ambiguity. A solid will drafted with the guidance of an estate planning attorney will likely cost you a bit more than a “will-in-a-box”, but may prove to be worth the expense. Complement your will with related documents. Depending on your estate planning needs, this could include some kind of trust (or multiple trusts), durable financial and medical powers of attorney, a living will, and other items.

Review your beneficiary designations. Who are the beneficiaries of your retirement plans and/or insurance policies? If you aren’t sure, it is probably a good idea to go back and check the documentation to verify and change, if necessary, who you have designated as beneficiary/(ies). Create asset and debt lists. You should provide your heirs with an asset and debt “map” they can follow should you pass-away, so that they will be aware of the little details of your wealth. Think about consolidating your “stray” retirement and/or bank accounts. This could make one of your lists a little shorter. Consolidation means fewer account statements, less paperwork for your heirs, and fewer administrative fees. Let your heirs know the causes and charities that mean the most to you. Write down the associations you belong to and the organizations you support.

Select a reliable executor. That person should have copies of your will, forms of power of attorney, any kind of healthcare proxy or living will, and any trusts you create. In fact, any of your loved ones referenced in these documents should also receive copies of them. Talk to the professionals. Do-it-yourself estate planning is not recommended, especially if your estate is complex enough to trigger financial, legal, and/or emotional issues among your heirs upon your passing.

Add these items to your to-do list:

 1. Get your affairs in order before you’re told to get your affairs in order. In particular, an Advanced Healthcare Directive will document your instructions of whether you do or don’t want artificial respiration, etc. Once it’s too late, then it’s too late. Do it now!

2. Record usernames and passwords for any online accounts you may have. It will be important for your executor.

 3. For accounts without beneficiary designations, add Transfer on Death (TOD) or Payable on Death (POD) instructions