Dukes County Health Council: Working for your health

Taxes, death, and advance care planning.

Dukes County Health Council offers a variety of Island services. — MV Times

In 1787, Benjamin Franklin wrote the French intellectual Jean-Baptiste Leroy about his hopes for the longevity of the newly drafted Constitution of the United States, and noted, “But in this world nothing can be said to be certain, except death and taxes.” April 15 has become synonymous with “tax day” for most Americans. Yet even that has changed. Income taxes in the U.S. were first collected annually on March 15 beginning in 1918. Only in 1954 was April 15 established as “tax day.” Specifics do change, but important issues like planning for the unexpected persist. The fact of death remains a certain future reality for us all.

In 2008, Nathan Kottcamp, a Virginia estate attorney, established National Healthcare Decisions Day after finding that too many of the families he served suffered because their loved ones had not revealed how they would like to be cared for in the event they could not speak for themselves. Too many of his clients had not designated anyone to speak on their behalf (a healthcare agent). Too many of his clients had not a “conversation” about “what mattered most” in their lives with those whom they trusted. The families Kottcamp worried about were left with doubt, guilt, and often conflict. Kottcamp believed this was all avoidable if his clients simply “planned in advance.”

Ben Franklin also stated, “If you fail to plan, you are planning to fail!” In the case of advance care planning, failing puts your family and friends at risk — of discomfort, of unnecessary suffering, and in some cases, of legal problems. According to the American Medical Association, advance care planning is “the process of planning for future medical care in the event that the patient is unable to make his or her own decisions.” It is a powerful but simple process that involves designating an individual to speak for you if you cannot speak for yourself (healthcare agent); having a conversation with your healthcare agent so they know what matters most to you, and can represent you in the way you wish; and making sure your choice of healthcare agent is easily accessible and known to people who will need to know if you cannot speak for yourself.

National Healthcare Decision Day is an annual reminder to plan for the future we might not want to consider — for the sake of ourselves and our families. There is nothing magic about April 16, however there is great power in discerning what matters most in life to you, and letting others know about it. Any day is a good day to do that.

Some questions for you to consider:

  • Have you designated a healthcare agent (also known as a healthcare proxy, or medical power of attorney)?
  • If so, do you know who it is? (Some of us forget, especially if we completed documents with our lawyer years ago. It is not enough for your lawyer to know.)
  • Does your healthcare agent know that you have designated them to speak for you? (It is surprising how many people complete a form designating a person as their healthcare agent, but neglect to speak with them.)
  • Is the form designating your healthcare agent easily accessible — i.e., somewhere where people can easily find it in an emergency? (Your lawyer’s safe deposit box is not a good place for it, if that is the only copy. Good places are in one’s home in a visible location; with one’s healthcare agent; and in your electronic medical record.)
  • Have you reviewed your selection of a healthcare agent recently? Have you reassessed what matters most to you now? (What mattered to you when you were 30 may be very different from when you are 70. As Ben Franklin noted, things often change with time.)

Some questions you might have, and some answers:

  • Who should choose a healthcare agent and have an advance care plan? Answer: Everyone 18 or older. Once a person turns 18, one’s parents can no longer speak for them. They must designate someone to speak on their behalf if they cannot speak for themselves. Remember, the leading cause of death in 18- to 30-year-olds is unintentional trauma. Think “traffic accident,” often with head trauma. Unfortunately, this is not a rare occurrence. Every adult needs to designate a healthcare agent.
  • Do I need a lawyer to choose a healthcare agent? Answer: In Massachusetts and surrounding states, the answer is no. The process is simple. The necessary forms are free and are readily available online from Honoring Choices MA. bit.ly/Health_Proxy
  • If I have questions on advance care planning, where can I get them answered? Answer: On Martha’s Vineyard there are several resources — Healthy Aging M.V. (on the web at hamv.org/advance-care-planning, or call); Hospice & Palliative Care of M.V., hospiceofmv.org), and any of our wonderful Councils on Aging (Edgartown: 508- 627-4368; Oak Bluffs: 508-693-4509; Tisbury: 508-696-4205; and Up-Island Council on Aging: 508-693-289).
  • Where can I get more in-depth information? Answer: The Conversation Project (theconversationproject.org); Honoring Choices MA (honoringchoicesmass.com). Also, look for workshops sponsored by Healthy Aging M.V. and Hospice and Palliative Care of M.V. at your COA, library, church, or social group.

Finally, reach out to your family and friends. Ask them if they have chosen a healthcare agent. You will be doing them, as well as yourself, a great service.