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Who can turn off life support?

Liz DeCarlo

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Help clients think through their choices for financial and medical designees.

Kasey Massatti, MBA, was helping her parents update their important documents, including a health care directive designating who would make the decision to stop life support, if necessary.

“Who do you chose?” she asked. Both agreed they wanted to designate the other. “But when we started talking about it," Massatti recalled, "it boiled down to neither one would ever pull the plug on the other, regardless of directives.”

Massatti started discussing this situation with her clients, noting how hard it can be to make that choice for someone you’ve spent your life with. “So I talk to clients about sometimes choosing someone who’s outside the family, but feels like family,” said Massatti, a seven-year MDRT member from Lancaster, Ohio. “If you’re not immediate family, you can sometimes remove yourself from the emotions and look out for the well-being of the whole family, versus being in that super-hard grieving period of what-ifs.”

Talking to clients about who they designate as executors, guardians and medical decision-makers takes both the ability to guide their choices and to deftly work through difficult conversations.

Asking questions

“We almost always have detailed discussions about the duties of someone who’s going to make medical decisions versus financial, and that sometimes it’s a different person,” said Timothy W. Murphrey, CFP, J.D., a 30-year MDRT member from Sacramento, California. “Having the client understand there’s a big difference between health care and financial power of attorney gives them some clarity.”

“I help clients make those decisions by asking them about relationships within their family and among adult children,” said Asvin Chauhan, Dip FP, MIFP. “If they don’t see eye to eye, who do they think can stand up and be accountable? Who understands the money side of it?”

Solicitors don’t give them guidance about who should be put in place, said Chauhan, a 20-year MDRT member from Coventry, England. So while an attorney is able to draw up a will or create a trust, they’re often not questioning who has been designated to carry out the client’s wishes.

“We as advisors should be asking clients, ‘Have you made your last wishes known? Can I see it?’” said Robert L. Avery, CLU, ChFC. “Ask about medical powers of attorney, ‘Have you updated them?’”

Avery, a 33-year MDRT member from Denver, Colorado, also suggests asking, “Who gets the money?”

“It may not be politically correct, but sometimes you have to ask, ‘Do you think junior can handle having $3 million in cash?’”

If the answer is no, it opens up a discussion of how things could be handled differently.

In discussions about who will handle various roles, Massatti will often say, “‘If this person is guardian for the kids, they might not be the best executor.’ We talk about putting them in a different role or having them as co-executor, or setting up with a lawyer to require both to sign on certain things.

“Ultimately, it’s their decision, but we do try to lead them if we know something they’re not aware of,” she said. “We try to get the person they want, who might not be the best choice, into an important role, but maybe not the executor or medical decision-maker.”

Massatti is currently working with longtime clients who are transitioning a large farm to the next generation. The husband is in the early stages of Parkinson’s disease. “That will be part of the conversation in the process, to ask the wife, ‘Is he the most fit person to be designated to make decisions, if necessary, for your medical needs?’”

We as advisors should be asking clients, "Have you made your last wishes known? Can I see it?"
— Robert L. Avery

Beyond the name

The decision of who to designate goes beyond who’s the most financially astute or has the best understanding of medical terminology. “A bigger issue is helping clients understand that the person they want to designate might have financial savvy, but if there’s conflict between the kids or spouse, that might cause a lot of trouble,” Murphrey said.

Chauhan also recommends asking clients if other family members will hold it against a spouse who decides to end life support. “We always have the spouse’s name to make the decision, but I’ll often say, ‘Who are the people who would point a finger at your spouse and blame her for that decision?”

Because he didn’t want his mom to ever say to his wife, “You shouldn’t have turned the machine off,” Chauhan has designated both his wife and mother as end-of-life decision-makers.

For Massatti, since neither of her parents could make an end-of-life decision for the other, she now has that role. “Although they didn’t want me to have to do that, they realized I could put emotions aside and do what’s best for the family.”

“The best thing advisors can do is settle for themselves and really think it through,” Chauhan said. “Then you can share your story with clients.”

And if it’s not possible to designate a client’s family member to any of these roles, turn it over to someone on the outside. “You can always hire professionals,” Murphrey said.  


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