AT the beginning of 2012, my mother was 95 years old. She lived in an assisted-living center, with hospice care, in a hospital bed 24/7. She was hollow-eyed and emaciated. Though she had moments of clarity, she was confused, anxious and uncomfortable. Her quality of life was minimal, at best. And the cost to keep her in this condition had risen to close to $100,000 a year.
hree years earlier, when she was completely rational, my mother told me that while she had lived a full and rewarding life, she was ready to go. By 2012, when her life was more punishment than reward, she did not have the mental faculties to reaffirm her desire, nor was there a legal way to carry out her decision. Even if my mother had been living in one of the states like Oregon, Washington or Vermont that have “death with dignity” statutes on their books, the fact that she lacked mental competency to request an assisted death by 2012 almost certainly would have ruled out any possibility that the state would have granted her wish.
Nor would it have been an option to move her to one of the few countries that have removed the legal perils of a decision to end one’s life. It was hard enough to get my mother from her bed to her chair. How would I have transported her to the Netherlands?
No, there is only one solution to this type of situation, for anyone who may encounter it in the future. What is needed here, I suggest, is not a death panel. It’s a “life panel” with the legal authority to ensure that my mother’s request to end her own life, on her own terms, would be honored.
I am staking a claim on the name life panel, because the concept of death panels has been so irresponsibly bandied about during debates about the government’s involvement in health care. But I really do not want to discuss politics here. I am a financial planner, and I want to focus on money.
The financial aspects of the end of life are an integral part of almost every plan I create. If planning is about getting from Point A to Point B, you do not get a bigger or more definitive Point B than your own funeral.
Some of my clients are extremely realistic about the crushing expenses they could face in their final years. Others are more sanguine. When I tell them that their money is unlikely to last through their 90s, they say: “Well, that’s O.K. I don’t plan to live past 85, anyway.” I have a standard answer in these cases. I say: “Yes, you expect to die at 85, but what if you’re unlucky? What if you live to 95?” At that point, I tell them about my mother. Then we get down to work.
Occasionally, people tell me that their end dates are guaranteed. They are saving pills that will put them out of their misery, or they have made “arrangements” with friends. For all their planning, my clients do not realize that when the time comes, they may be too sick or demented to carry out their do-it-yourself strategies. And so we come back to the life panel. Who is on it? Certainly, a doctor would be involved. After all, we laymen might feel guilty about making decisions that would hasten the end of a life, but under current law in most states, doctors would be guilty — of murder. On a life panel, a doctor would be held blameless. And I would have no problem adding a medical ethicist and a therapist.
Most important, I think the individual should be allowed to nominate panelists who are likely to understand the person’s wishes: family members, close friends, a person with whom they share religious beliefs.
This may seem like a reach, but in fact we already come quite close to this now. As any financial planner will tell you, everyone needs a living will. This is a legal document that instructs a surrogate or a medical center on the level of life-prolonging or palliative care you want if you become unable to make medical decisions.
But legal documents go only so far. Doctors I have asked about this issue know firsthand the uncertainties of deciding when a person has lost medical decision-making capacity. Nor is it possible to write out instructions for every possible medical eventuality.
A life panel might not be the perfect solution, but neither is draining a family’s resources to support a joyless existence in a hospital bed.
Those who understand the high cost of quality care often compliment me on what a good son I am to pay so much for my mother for so long. The truth is, it was her money. But it was my money, and my children’s money as well, at least according to my mother. My parents did not want to “die with just a dollar.” They worked hard behind the counter of a small retail store to leave money to their children. It was of primary importance to them, as it is to many of my clients.
So what should have been done for my mother?