Many of our clients find finalizing their estate plans as great hurtles, specifically the decisions required of them when drafting a Medical Power of Attorney and/or a Living Will. A Medical Power of Attorney is a document used when you are alive, yet unable to make these decisions for yourself. Similarly, a Living Will is a document that spells out medical treatments you would and would not want to keep you alive. Many people wrestle with the sections regarding artificial nutrition administration, life-supporting treatments, as well as the decision whether or not to be an organ donor. These decisions are often carried out while in the Intensive Care Unit (ICU) for end of life care, sudden illness, surgery, or injury and accidents. These estate planning vehicles are an essential portion of your Estate Plan, and should not be neglected due to it providing difficulty! We’ve had clients share with us these decisions are the greatest barriers in not finalizing their legal documents - whether they don’t want to think about these tough subjects or they can’t make an informed decision. At Legacy Planning and Probate, we aim to make these difficult conversations more approachable and manageable.
To better serve our clients, we interviewed Megan Kelly, an experienced ICU nurse, to get a better understanding of how these decisions play out in the ICU unit. Below you’ll find the 5 most common questions clients ask us to help them understand with an experienced ICU nurse’s shared experience. Megan answers with first-hand information for consideration. None of the information presented in this post is considered medical advice nor should be treated as such. We hope the interview demystifies an uncomfortable concept to consider in a matter-of-fact and gentle approach, giving you the words to engage in the necessary conversations with your potential agents and medical care team.
You can follow her on Instagram @nurse.megank
Megan Kelly is a seasoned nurse with over 14 years of ICU expertise from coast to coast! As a bedside nurse, Rapid Response/Code RN, critical care transport nurse, COVID-focused ICU, and has even served on an ambulance with first responders in a major city! She has been on the front lines of healthcare working closely with families and patients during their toughest moments. Megan found herself confronted with being personally affected with these Medical Power of Attorney decisions when her husband was diagnosed with aggressive cancer in his 20s. A decade has passed, and he is now thriving cancer-free, which drew Megan to become passionate about demystifying stays in the ICU, both from a patient and family-member-of-a-patient perspective.
Legacy Planning & Probate: Many clients are hesitant to put in writing they want to be an organ donor because they’ve heard doctors and nurses don’t “try as hard” to keep a patient alive if they’re a designated donor. What can you share about this to help our clients make a more informed choice?
Nurse Megan Kelly: I’ve never understood where this theory comes from. In all my years of patient advocacy as a charge nurse or serving directly as an ICU patient's primary nurse, I’ve never known their organ donor status to factor into the level of care a patient receives. If a patient is coding, I’m going to do everything in my power to keep them alive. The only case I could see a care team not “trying” to save someone is if they have a specific order on their chart to not receive life-saving interventions, which is a different conversation. Typically, organ donor status is only revealed when the organ donation team has been contacted about a potential patient. To further explain: every patient that comes into the hospital that meets certain criteria will be evaluated by the organ donation team regardless of donation status! The family will only be approached by the donation team if the patient meets criteria deemed to be a potential donor. Those conversations will usually take place once end of life has shown to be a near possibility or care has shown to be futile. Also, that conversion will never be had with the medical team in the room, and is normally a private conversation between the family (or someone given authority with the MPOA) and the highly trained donor team. According to the official Organ Donor website, when making the choice to donate your healthy tissues and organs, you could potentially save 7 people’s lives and enhance over 75 more; this is incredible. Being an organ donor means that you have had a conversation with yourself and your loved ones, and made it known that it is something you would want to happen if placed in that situation. However, if you choose to not be a donor, it is still a respected choice.
LP&P: What exactly is “artificial nutrition”?
NMK: Artificial nutrition is such things as tube feeding (liquid food basically) given through tubes either in the nose, mouth, or stomach. This intervention is used to provide nutrition to a patient that can no longer safely swallow food or medications. For instance, artificial nutrition is used when a patient is placed in a medically induced coma. It could also be used when the patient may be very confused so swallowing is hard and unsafe. There are many instances in which this form of nutrition is needed but the time line varies from patient to patient and the time frame can range from a few days to permanently.
LP&P: How can clients better choose how many days to receive an intervention such as artificial nutrition? Please tell us how it’s used in the ICU.
NMK: When considering the number of days you wish to receive artificial nutrition, it’s important to understand the feeding program has been initiated for a specific purpose. The medical team will consider if they foresee you needing this form of nutrition for an extended period of time or if this is needed while you heal and get stronger. Someone filling out their wishes on their MPOA would want to consider if this intervention affects their perspective on their quality of life or is something they don’t want for personal reasons. This answer may change as someone ages or receives a diagnosis with specific prognosis outcomes to think about.
LP&P: Clients seem to have the most difficult time in how to approach their decision regarding life-supporting treatments. What should they consider before selecting the number of days to potentially receive this care?
NMK: I understand the weight of this decision - the balance between time for a fighting chance yet not wanting to live on machines with no prospects of meaningful life. To begin with this decision, most people are surprised to learn how long it takes for the care team of a new ICU patient to create a specific treatment plan. Sometimes it could take more than three days for all the doctors and staff on the team to even establish a plan! This often frustrates family members in the moment, as they feel their loved one is being forgotten or pushed aside. This is not the case! A patient in the ICU is there because their body is requiring dramatic intervention that often involves multiple specialties. These different providers must agree on a plan that works together for the good of the patient's hopeful recovery. I would urge people making the decision on the number of days for this intervention to take this decision window into consideration - first and foremost. Secondly, I’d have people understand bodies often just need time to heal! Time is often what the ICU patient needs for doctors to see if a treatment plan is working, obtain necessary images and blood work, or recover from a series of surgeries. For example, I had a patient who experienced a terrible skiing accident. The care plan required multiple surgeries with up to four days between each stage of the patient’s surgery plan for recovery. These days included time for lung healing, swelling and bleeding management, pain management, and so on. This patient needed time to heal and made a full recovery thanks to the predetermined choice to remain on life support for some time. I’ve also cared for a patient who had an accidental exposure to fentanyl while on a vacation with friends, and, though he was not going to recover, needed time to remain on life support so his wife could fly out to the area and have proper closure. This example illustrates the importance of considering who you’d want to be there for you and how long travel would be for them to come at your time of need; this should be calculated in your consideration. Another example for those making these decisions: I’ve cared for terminally ill patients who updated their Medical Power of Attorney once their disease condition and prognosis changed. They, with the help of their care team, discussed options and what each day on life-support could potentially offer (or not offer). After considering these distinctly different ICU stays, I would like to highlight the importance of updating your Estate Plan, specifically the wishes specified in your Medical Power of Attorney, as you experience different chapters of life!
LP&P: When considering the agents to appoint to oversee medical care when clients are incapacitated, what advice would you give regarding this decision?
NMK: Navigating medical decisions for someone else is a profound responsibility, one that requires careful consideration and empathy. A prudent choice for your Medical Power of Attorney is someone you trust to carry out decisions on your behalf as you would, even if they may not agree with your choices. I’d suggest considering someone who knows your intimate opinions on how you want to live your life, someone who is privy to certain medical decisions you’ve made in the past for yourself and respects your personal beliefs. You want your agent to keep the focus on you - the patient; it’s challenging (especially in end-of-life discussions where the idea of losing a loved one can be overwhelming) to minimize the influence of personal fears and emotions. Additionally, consider someone you trust to ask the types of questions you’d want answered before making medical treatment decisions, and someone who can weigh the long-term impacts of their choices. As an ICU nurse caring for patients while simultaneously being a presence for an agent in the midst of this challenging journey, there are three key reflections I suggest to make the process more manageable: (1) does this align with who they are as a person and their beliefs? (2) Will my decision cause them more harm than good? (3) Is my decision influenced by my emotions or their best interests? Making these decisions for someone else is undeniably one of the most difficult tasks one may face. I encourage everyone to engage in open discussion with their loved ones, fostering a deeper understanding of their preferences and wishes. Holding space for this before the tough decisions have to be made is a proactive approach to provide valuable insights with compassion and clarity!
This information, combined with discussions with your health care provider, could assist you in making sound and informed choices regarding these care wishes. Access our Instagram page under the “Medical POA” highlight tab for more information as we interview Nurse Megan!
Disclaimer: The information provided on this blog post should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician. Always seek the advice of your doctor or other qualified health provider regarding a medical condition. Information provided on the website is not to be construed as legal advice. No attorney-client relationship is formed between the website owner, its blog guests, nor the website visitor.