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🔑 Key Takeaways for Advisors
1. Legal Foundations and Common Tools
Advanced Directives and Living Wills: Essential legal documents recognized in every U.S. state, used to outline treatment preferences. Advisors should ensure these are clearly written, witnessed, and ideally included in a state or national database (e.g., MyDirectives: mydirectives.com).
Healthcare Proxy Designation: It’s not enough to appoint a trusted individual—the proxy must be prepared to advocate assertively for the patient’s wishes. This role may require conflict resolution and communication with healthcare providers.
POLST/MOLST Forms: These are medical orders for life-sustaining treatment and vary by state. Advisors must ensure that clients in late-stage illness discuss these with their physicians. See polst.org for state-specific details.
2. Gaps in Implementation and Litigation Triggers
Document Disregard in Hospitals: Even with properly executed directives, hospitals sometimes ignore DNR/DNI orders—leading to unwanted interventions like intubation or resuscitation. This occurred in states like West Virginia, New Hampshire, and California.
Reasons for Non-Compliance:
Hospitals fear legal liability for not attempting resuscitation.
Healthcare proxies may not assertively enforce the patient’s wishes.
Lack of staff training or unfamiliarity with directives in emergencies.
📚 See: Journal of the American Geriatrics Society, 2020 – "Barriers to Implementing Patient Preferences for End-of-Life Care"
3. Dementia-Specific Planning
Cognitive Decline Considerations: Traditional directives may not hold up once cognitive capacity is lost. Patients should draft instructions while competent that address:
Withholding food and hydration (including "comfort feeding")
Preferred settings of care (home, hospice, memory care)
Specific triggers to initiate comfort-only care
Use tools like the Dementia Values & Priorities Tool from Compassion & Choices: Dementia Planning Tool
4. Voluntarily Stopping Eating and Drinking (VSED)
VSED is a legally recognized way to hasten death in many states, supported by palliative care. It is not equivalent to suicide.
Advisors should know VSED is especially relevant when medical aid in dying (MAID) is unavailable or not desired.
See: National Library of Medicine – Voluntarily Stopping Eating and Drinking
5. Medical Aid in Dying (MAID)
Legality: Available in 11+ states and D.C., with variations in procedures, residency requirements, and documentation.
Latest: Delaware and New York laws take effect in 2026 (pending governor approval in NY).
Current map: Compassion & Choices MAID Map
Eligibility Requirements:
Terminal diagnosis (≤ 6 months prognosis)
Mental competence
Self-administration capability (i.e., swallowing or minimal aid)
Planning Considerations:
Review life insurance and estate documents for clauses excluding MAID-related deaths. Most MAID laws explicitly state that deaths are not suicides.
Family involvement is essential—lack of transparency raises suspicion and undermines the process.
6. Litigation Prevention
Common triggers:
Family disputes over proxy rights
Religious objections from institutions or family members
Conflicts between state law and family wishes (e.g., South Carolina’s 6-hour delay rule before an advanced directive is honored: § 44-77-30)
Advisors should review:
State-specific laws (e.g., Nevada permits withdrawal of nutrition via GI tract; West Virginia mandates oral feeding regardless of directives)
Client residence and facility location—state of death can impact legal jurisdiction and death certificate language.
🧠Strategic Advice for Advisors
Start early: Encourage planning before diagnosis or crisis.
Don’t assume: Review documents regularly and update based on changes in law or health status.
Involve professionals: Collaborate with end-of-life counselors, estate attorneys, and palliative care providers.
Document everything: Have clients include letters or videos articulating their wishes in plain language.
Normalize the conversation: Build death literacy through proactive client education.
đź“ž Resources for Support
Compassion & Choices Legal Helpline: 800-247-7421
End-of-Life Counseling: compassionandchoices.org
Dementia Planning Tool: compassionandchoices.org/dementia-values-priorities-tool
Advance healthcare directives may be void for pregnant women; certain hospice facilities may refuse to engage in medical aid in dying; and I had never considered checking life insurance documents! I learned ALL of the things. This was the best webinar yet! And I love your webinars, thank you!
- Tanisha C.
I "got" the major point that Veronica made - that just filling out the advanced care directive is NOT enough. And the subtitle: dying a death you want, in out culture and time, is as exhausting and complex as living.
- Andrea M.
Learned a few new conversations topics by defining new words I did not know before. Better understanding of how to position the conversation.
- Sean K.
The nuance of how capacity plays a role in using either Advance Directives or MAID in planning, how Advance Directives can be revoked verbally.
- Michelle F.
Attendees Comments:
Advance healthcare directives may be void for pregnant women; certain hospice facilities may refuse to engage in medical aid in dying; and I had never considered checking life insurance documents! I learned ALL of the things. This was the best webinar yet! And I love your webinars, thank you!
- Tanisha C.
I "got" the major point that Veronica made - that just filling out the advanced care directive is NOT enough. And the subtitle: dying a death you want, in out culture and time, is as exhausting and complex as living.
- Andrea M.
Learned a few new conversations topics by defining new words I did not know before. Better understanding of how to position the conversation.
- Sean K.
The nuance of how capacity plays a role in using either Advance Directives or MAID in planning, how Advance Directives can be revoked verbally.
- Michelle F.