Quick PSA

As college students head back to college, I wanted to remind parents that their college bound children should have a set of documents in place so the parents can access their medical info and make medical decisions if something terrible were to happen to their student. Once the child is 18, the child is in charge of their own decisions and hospitals do not automatically defer to the parents' decisions.

Students should have a health care power of attorney, HIPAA release, living will, and financial power of attorney. I prepare the set of documents for a reduced fee of $150.

Parents are on their own in trying to access their child's grades and tuition bills.

Pic is from Jack's first day at OSU last year.

Not All Tattoos Are Pointless

When an unconscious Florida man was brought to a hospital without identification but a tattoo that said “Do Not Resuscitate” and a signature, doctors were surprisingly faced with what to do with the dying man. They first thought they should disregard the tattoo because it might not reflect his current wishes because he might have gotten it when drunk. An ethicist later over-ruled the doctors and said that his tattooed wishes must be respected.The man eventually died. An NYU ethicist quoted in the article said that people should carry their health care directives with them to prevent these problems.

Several points:

1. Sad that the hospital was at first going to ignore something as obvious as the man’s tattooed wishes. Even if he were drunk when he obtained the tattoo, he could have remembered to remove it any time whenever he saw himself and the tattoo in a mirror.

2. I have scans of all my clients’ documents and have occasionally been asked to send them to a hospital while I have been out of town. The cloud can be a tremendous tool.

3. Carrying one’s health care directives in case of emergency seems like an extreme command by the ethicist especially in the case of homeless folks who are simply trying to push a cart with their blankets and clothes and looking for food. Neatly preserved health care directives would seem to be low on the priority list.

4. Moving beyond homeless folks, asking folks to carry their health care directives while they run to CVS or Sam’s Club seems burdensome. This is further proof that the academic world is not the real world.

Photo Credit:  New England Journal of Medicine
License:  Fair Use/Education

Prayers For Otto

Otto Warmbier is the Cincinnatian who was held captive by North Korea for 17 months for allegedly trying to steal a propaganda sign on a college visit. While starting to serve a 15 year sentence of hard labor, he was beaten so severely that he suffered a brain injury and returned home Tuesday night in a coma. Doctors at the University of Cincinnati Medical Center have described his condition as "unresponsive wakefulness."

One small legal point:

1. Once a child turns 18, I encourage parents to have their child sign a health care power of attorney, living will, and HIPAA Release so the parents can access their child's medical records and make medical decisions for them. Without those documents, the parents might be stymied in making decisions in the best interest of their child.

2. This story breaks my heart. No snark here out of respect for Otto and his parents. Tell your child you love him/her tonight.

Photo Credit:  Christopher Oquendo for dailymail.com
License:  Fair Use/Education

She Didn't Know (Updated)

Now that Bobbi Kristina Brown has died after six months in a coma, let's revisit what will happen to her estate and her mother's estate, while also covering what she should have done differently.  To recap, Bobbi Kristina was a month shy of 19 years old when Whitney died.  Whitney's 1993 will created a trust solely for the benefit of Bobbi Kristina.  The trust distributed 10% of Whitney's estate to Bobbi Kristina when she was 21 with the remainder to be distributed at the ages of 25 and 30.  Bobbi Kristina received approximately $2 million on her 21st birthday.  After Bobbi Kristina was found unconscious, her father (Bobby Brown) and grandmother (Cissy Houston) made her medical decisions for her somewhat contentiously.

What should have happened?

1.  Whitney should have provided that her estate be distributed to her daughter at an age later than 21.  I never draft trusts with such a young age for principal distribution.

2.  When Bobbi Kristina received her first distribution from her trust, she should have created a will of her own which would have enabled her to leave her $2 million to her "husband"/adopted "brother", Nick Gordon.

3.  Upon turning 18, Bobbi Kristina should have executed a health care power of attorney, living will, HIPAA release, and financial power of attorney designating a specific family member to handle her affairs if she were disabled.  I always recommend this for my clients whose children are heading off to college.

4. None of this was done.  Of course, I doubt that basic estate planning was a priority for a family prone to alcohol and drug use while bathing.

You Are Only As Good As Your Surrogate

I am sure you have seen this, but it is still worth commenting on.  A 13 year old California girl suffered tragic complications after undergoing sleep apnea surgery and was declared brain dead by the physicians at the hospital where the surgery was performed.  Her family has contested the "brain death" declaration and has had her transferred to an disclosed facility with beliefs similar to theirs.

Two major points (no snark with these horrible circumstances):

1.  Adults can avoid the ramifications of a similar situation by executing a living will about their intentions if declared brain dead and by designating a health care surrogate to act in their stead via a health care power of attorney.

2.  The declaration of intent and designation of a surrogate are only as good as the person tasked with carrying out one's wishes.  Be sure that the surrogate shares one's intellect and values, and respects one's wishes.

Getting One's Act Together

In the making lemonade out of lemons department is this story about a woman whose 43 year old husband died after his bicycle was hit by a motorist.  The couple had unsigned wills, no emergency savings, financial accounts with passwords the wife did not know, but some life insurance.  The widow created a web site to encourage others to avoid her financial calumny and to essentially take steps to become a responsible adult by executing a will and other financial documents and by assisting with passwords and other financial knowledge.    

When prioritizing allocation of financial resources to major decisions, I recommend the following:

1.  Life insurance.  Provide financial security for the spouse and children.

2. Living will and health care power of attorney.  Do not bankrupt the family because medical decisions can not be made.

3.  Will.  Clarify distributions and designate a guardian.  

Somewhat related, the article did nothing to dispel my fear of riding my bike on the road rather than a bike trail.    

Who Controls End of Life Decisions?

Sad case that I intended to link last week.  A young woman was diagnosed with terminal brain cancer and eventually received a breathing tube. When she requested that the tube be removed so she could die, her parents sought guardianship of her.  A court found her competent to make her own decision and denied her parents' request. In an odd turn of events, she changed her mind and kept the tube in place to preserve peace with her parents.

A few points:

1.  The case was correctly decided.  The parents had no right to interfere in the decisions of their adult child.

2.  If she had not been found competent, she would have been best served by having a health care power of attorney which designated someone who shared her beliefs to make her decisions. 

3.  We all should have conversations with our family members so they know our wishes and how we wish they would respond to specific medical situations.  As tempting as it might be to get all potentially controversial topics on the table at once, save the conversation about differing views on religion, political candidates, and gay marriage for a different time