Ideas. Lessons Learned, and Occasionally, Opinions


On October 2, 2017
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When we talk about medical decision-making, especially in the later stages of life, there is a huge disconnect in our society between attitudes and implementation.

In fact, according to the American Journal of Preventive Medicine, only 26% of Americans have living wills or advance directives, even though 86% says it’s important to have their wishes written down. 

As a financial professional who cares about your clients’ lives and the impact of healthcare on their finances, make it a part of your practice to recommend advance directives for every client, and offer the following basic information as a guide. 

In broad terms, an advance directive is any document that allows a person to state “in advance” how they wish to be treated if they are unable to make those choices themselves. The most common advance directive is a living will. Contrary to what many people think, living wills do not have to limit treatment or “pull the plug”; they can also be used to request every medical intervention available. It is up to your clients to state what they wish.

Also, if someone is conscious, capable of making decisions, and able to sign permission forms, there is no need to consult the living will. Living wills only take effect when a patient is unconscious, demented, in the recovery room after surgery, highly medicated, or otherwise incapable of making their own decisions.

Rather than a cursory document with a couple of boxes checked off, the living will ideally is the clearest description possible of that person’s desires. Clients often list their wishes based on various situations, as they may want different treatments when imminently dying of cancer than when in a coma from which recovery is likely. Because perspectives change with age and state of health, these documents should be revisited at least once a year.

The advantages of living wills:

  1. They keep clients in greater control of their lives as well as their deaths, even in cases where they are unable to speak for themselves
  2. They can promote honest conversations within families.
  3. They can help prevent legal battles and courtroom fights.
  4. Survivors of a loved one’s death grieve with fewer regrets and less guilt when they do not have to make treatment decisions without clear instructions from the dying person. 

Common problems of living wills: 

  1. Only a small percentage of people complete one, and when they do, over half do not give copies to anyone. A living will kept in a safe deposit box or desk drawer is inaccessible when decisions need to be made.
  2. As noted previously, the perspectives of a healthy, active person can change dramatically when they actually become ill, and too few people update their documents as they age or diminish.
  3. Living wills are not legally binding upon healthcare professionals, and uninformed family members sometimes override them. The clients’ families, and especially their powers of attorney for healthcare (aka healthcare proxies), need to be informed of their wishes, so they can support those desires with medical providers.
  4. Although they are valid across state boundaries, each state has their own form. Clients who use the standard living will must therefore complete the form provided by the state of primary domicile. 

Just because there are a number of valid concerns about living wills doesn't mean that financial advisers should discourage their clients from creating the documents. Instead strongly encourage clients to write their desires as clearly and specifically as possible.

Some of these concerns are addressed by another form of living will. Consider giving your clients a form called The Five Wishes. It is available at for $5 per copy, or $1 per copy when purchased in quantities of 25. It’s a very inexpensive way to provide real value to clients and their families. 

The form includes everything found in a standard living will from the states. It also includes one legally binding part: The appointment of power of attorney for healthcare. Additional directives include comfort measures a person desires in their room (music, lighting, blankets, religious items), messages to leave with loved ones, and wishes for services. It is a more comprehensive form than the states provide, and almost all states accept it in lieu of their standard form. The only exceptions are AL, IN, KS, NH, OR, OH, UT, and TX, which accept it as long as it is attached to that state’s standard form. 

In other words, The Five Wishes is a more complete form that addresses several concerns rather than only one, and it is accepted in every state (given the minor restriction in the eight states named.) If you are working with estate planning attorneys in your COI network, inform them of The Five Wishes and of your desire to have all of your clients use that form. Then there is less chance of discrepancies and overlap between your work and theirs. Like all forms of this nature, the latest one that is signed, notarized, and dated supersedes all previous copies, so it is not a problem to complete the more comprehensive form even for clients who completed the state’s standard form already.

Regardless of what form clients choose, schedule a follow-up to ensure they actually do complete a living will/Five Wishes, and that it is properly signed and notarized. Encourage them to distribute copies to their family members and to any person or institution involved in their care, including primary doctors, specialists, nursing home, hospice, rehab center, and hospitals. Offer to keep a copy in the client’s files at your office, in case a family member needs one and cannot locate it.

When you educate your clients and prompt them to complete a living will, you ease their fears that someone else will dictate their medical decisions. You keep them in greater control and take a burden off their family members. The resulting peace of mind is invaluable to your clients and consequently good for your business.

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