Will Your Health Care Directives Protect You?

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For decades, financial experts like myself have implored clients to have a health care power of attorney. Now, some health care experts say you don’t need one because they don’t work.

"Decades of research demonstrate advance care planning doesn’t work. We need a new paradigm." That jarring statement came from Dr. R. Sean Morrison, chair of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York. He is a co-author of a paper written for JAMA, October 21, 2021, and was cited in an article by Judith Graham published January 6, 2022 at Kaiser Health News.

One reason for the limited value of advanced planning, according to the medical professionals interviewed by Graham, is the difficulty of trying to anticipate the almost limitless hypothetical scenarios that may present themselves at the end of one's life. "Many highly educated people think documents prepared years in advance will protect them if they become incapacitated. They won’t," said Dr. James Tulsky, who is chair of the department of psychosocial oncology and palliative care at the Dana-Farber Cancer Institute in Boston.

This is strong medicine for the "highly educated people" in the financial planning and legal professions who have long preached that having a will and durable powers of attorney are Estate Planning 101. My first response was to wonder why the medical profession has apparently sold us an empty promise that patients' wishes would be treated seriously. My second was to wonder whether financial and legal professionals were assuming promises that the medical professionals never made.