For Clients, Advisors and Community.  There was recent news that Facebook users could register as organ donors.  This development gave great publicity to the fact that 70% of individuals would accept a donated organ if needed but only 30% are registered to be organ donors.  The result has been a well publicized shortage of needed organs for transplantation.

Please note that looking for an organ donor page on FaceBook and reading the stories there is an ineresting source of information.  However, “liking” a page on FaceBook does not register you as an organ donor.  You must find a specific website for organ donation to be registered.  There are several on FaceBook. 

How in Illinois do we most effectively indicate our desire to act as organ donors?  Or, conversely, how do we indicate that we do not want to be organ donors?  There are several steps.

First and foremost, make sure that your loved ones and, in particular, your agent under durable power of attorney for health care knows your intention.

Second, the new statutory form of health care power of attorney has a place to indicate whether or not you want to be an organ donor.  And, if you do, whether or not you want to place any limitations on donation.

Finally, if you want to be an organ donor, you should know that the best way to indicate your desire is to register with the donor registry sponsored by  the Illinois Secretary of State.  The indication on your driver’s license is not legally binding.  However, if you register at http://www.lifegoeson.com your decision will be legally binding upon your loved ones, perhaps reducing or eliminating conflict at a difficult time.

I’m a believer in organ donation.  I’ve seen how this selfless act has enriched the lives of others.  As an attorney, however, my obligation  is to see that my clients’ desires are fulfilled irrespective of my personal beliefs.

Indicating your desires via Facebook is one way to inform your family and loved ones about your intentions.  It is also a great way to remind your friends and family concerning this important and timely topic.

For Clients, Community and Advisers.  I am often asked about the mechanics of implementing a DNR (Do Not Resuscitate) Order.  Many elder or infirm clients do not want to spend their last months dragged through extraordinary medical procedures.  Rather, they choose to have a natural death without having the medical establishment bring out the paddles every time they arrest or have breathing trouble.  There is a pronounced tendency toward a nuanced and calm end, at home with loved ones – not in a hospital with a sterile environment.

In our practice, we always offer our clients a durable power of attorney for health care as part of their estate plan.  (In Illinois, normally do not use the “living will” as its equivalent provisions are included as part of the durable power of attorney for health care.  In other states including Florida and Wisconsin, it is different.)  Many of our older clients come in to the office asking that we include a DNR order in their power of attorney.  What is a DNR order and how does it work (under Illinois law)?

There was a new DNR order form developed by a task force and issued by the Illinois Department of Public Health in 2005.  It requires the signature of the patient (or his /her legal representative such as an agent under power of attorney if he or she in incapacitated and cannot make a decision or sign) and a witness.  To be valid, it must be signed by the patient’s physician.  The physician’s signature is required not for consent, but rather to ensure that patients are getting appropriate counseling concerning a critical life and death decision.

There are basically two options.  The first is whether or not CPR should be attempted in the event of cardiopulmonary arrest.  Typically, for an individual who wants a valid DNR order, the answer would be, “no”.  (Do No Rescusitate)  The second is whether or not CPR should be attempted in the event of a pre-arrest emergency (when breathing is labored or stopped, but the heart is still working).  Here, the answer could be yes or no.

In appropriate circumstances, we will prepare the DNR paperwork for our estate planning clients as well as those clients who are members of our Family Lifetime Care Program (our continuing service program.  For more information, call me).  It is important to keep in mind, however, that a valid DNR requires a physician’s signature.  The DNR order should be completed well in advance of any emergency.  A copy of the document should be kept in your medical record with your physician, the hospital you normally use and a copy handy in your home for any emergency.

End of life care decisions are always sad and often difficult.  Nonetheless, all of us need to face them at some time.  Planning makes this task much easier for each of us when our time comes; but also for our families and our loved one.

For Clients, Community and Advisors. 

I’ve spent 30 years counseling clients in making choices and giving directions concerning durable powers of attorney for health care and end of life treatment.  In the last week, I came face to face with the inevitable decisions that families of my clients have been forced to make.  Being a “client” makes me more aware of the very real gut wrenching decisions that families have to make every day.  I should explain.

Two weeks ago, my 85 year old father was to have a minimally invasive aortic valve replacement and a stent put into an artery.  We were delighted we’d found a young surgeon whose “niche” was this type of surgery.  Unfortunately, once the operation started, they discovered that the blocked artery would not take the stress and he had a conventional “open heart” surgery.  He subsequently got pneumonia and other complications and has been in intensive care for the last two weeks.  I just spent a week in Tucson where they live helping my mother and coordinating his care.

Dad was on a ventilator on at least three occasions.  Over last weekend, they recommended that he have a tracheotomy so that they could deal more effectively with the pneumonia.  You see, my Dad would never want to live unable to talk or eat.  That is not the quality of life he would want.  My Mom was certain of it.  But, also, Dad is a fighter.  He wouldn’t want us to give up.  Should Mom consent to placement of the tracheotomy?  His health care power of attorney gives her the authority.

I insisted that we consult with the surgeon who stated emphatically that we were not at a futile point.  After a  very difficult afternoon of phone calls with my sisters, Mom decided to consent to the procedure (which was performed yesterday without incident).  We hope that the “trache” will allow him to recoverf from the pneuonia quickly and get him on his way to recovery.  It will certainly be a long, slow road.

What lesson can I offer my clients and their advisors from my own family’s recent experience?  Of course, it is important to have a durable power of attorney for health care.  That determines who gets to make the final decision.  It also gives some general direction on end of life care.

But, most importantly, talk to your spouse or your agent about what you would want and, perhaps even more importantly, what you would not want.  (Some of our clients, for example, don’t ever want to be put in a nursing home.  Others don’t want to be given psychotropic medications.)

The durable power of attorney is only a starting point.   We are pleased to add any and all specific directions clients want in their health care power.  Our objective is to customize your estate plan to exactly what you want.

More and more of our clients have annual reviews of their estate plans with our firm.  This is the case exactly and precisely to ensure that their important and current objectives are incorporated into their plan.   In the end, we want their estate plans to work just as they wanted.