To Have and to Hold and ... Be My Healthcare Proxy?

To Have and to Hold and ... Be My Healthcare Proxy?

In our “Money Mic” series, we hand over the podium to someone with a strong opinion on a financial topic. Today, writer Sebastian Stockman chronicles his decision to draft a health care proxy with his spouse.

“Can you make me a promise?” I asked my wife several years ago, well before we were married. “If I ever have a stroke or I’m in a car accident and I’m a vegetable, you’ve got to promise me something.”

“What’s that?” she asked somberly, because I was somber.

“No matter what,” I said. “Never, ever unplug me.”

She thought I was joking, so she laughed. Then she realized that I wasn’t.

“That is not a fair thing to ask,” she said, adding something about the psychic toll it would exact on our then-hypothetical family.

I can listen to reason, so I noted that she’d be free to divorce me and continue with her life. All I wanted was her assurance that she would leave me to my coma.

“You wouldn’t have to do anything,” I said. “You wouldn’t even have to visit. Just leave me plugged in.”

It’s not that I fear death … well, OK, it is that. But, also, who really knows what might await on the other side of the coma? I’m sure this cling-to-life impulse is informed by the ludicrous, miracle awakenings on television dramas. I knew better, of course, but even the grotesquerie of the Terri Schiavo case (which, I believe, prompted my discussion with Katie in the first place) couldn’t dissuade me. I want to LIVE!

Katie, however, was unpersuaded. Apparently, there was some aspect of this issue—the emotional distress of the non-comatose—that I was failing to take into account. So we tabled it.

Signing Over My Life

Over the next few years, we bought a condo, got married and had a baby. In anticipation of the joyous occasion of our daughter’s birth, we found ourselves in the office of a law firm in downtown Boston, where, in addition to our wills, we were each to sign durable powers-of-attorney and health care proxy forms. My signature on the health care proxy would assign to Katie “the authority, without limitation, to make any and all health care decisions on my behalf, including, without limitation, decisions regarding withholding or withdrawal of life-sustaining procedures.”

Translation: She’d be free to pull the plug.

Of course, I’d known this in theory, but I didn’t digest the fact until I read it in humorless legalese, just before I was to affix my signature to the document in front of two paralegals. It felt like bad form to balk now—bad form, and expensive, since our lawyer’s rate is $425 per hour, and the firm’s cheapest paralegal runs $150.

Only some time later did I dare to read the rest of the document. (Yes, Dad, I signed it without reading the whole thing):

“The following declaration is for the guidance of my Health Care Agent and any other who may require guidance … : I declare that I would not want to be kept alive in a state of diminished capacity, dignity and enjoyment by artificial life-support systems, such as a respirator, cardiac resuscitation, artificial nutrition or hydration, or other extraordinary measures which would merely prolong my dying if I were terminally ill, or in a persistent vegetative state …”

Wait, what? Yes, I would want to be kept alive, regardless of my diminished capacity, dignity or enjoyment! In signing the proxy, I apparently also signed a Do Not Resuscitate order.

Let's Define "Reasonable"

A few days later, while out to dinner with friends in Harvard Square, I played off my anxiety by joking about our differing dispositions regarding life extension.

“As soon as I hit the I.C.U., she’ll be like, ‘Time of death, call it!’ ” I said, pretending to look at my watch. “ ‘No, no need to turn on the ventilator. Tag ’im and bag ’im.’ ”

Our friends laughed, but Katie affected a pout.

“I’ll be reasonable,” she said.

Unfortunately, that’s the problem. For Katie, “reasonable” might mean waiting as few as, say, 36 hours. I, however, would be happy hanging out for 36 years, if necessary. You never know what medical science might turn up.

Beth Israel Deaconess Medical Center provides a brochure on choosing a health care proxy. The brochure urges the patient to consider, among other questions, whether or not “the [proxy] would be able to make the same decisions you would regarding your care.” Well, Katie would be able to make the same decisions—she just disagrees with the decisions I would make.

Stayin' Alive

One of the big issues here is one that’s much in the news as of late: How much health care is enough, and who should pay for it? The question of how much is enough—especially at the end of life—is an individual one that's different for everybody.

But the second part of that question affects us all.

When we signed those documents, Katie and I still kept separate bank accounts. But we also had a joint checking account and a mortgage together. She was on my employer’s health plan then; I’m on hers now. Most insurers aren’t interested in spending an indefinite amount of money to keep clients breathing on machines for decades on end. We’d have to pay for it somehow, and if Katie were to honor my wishes, she’d eventually have to go into bankruptcy, sell the house and then she and the baby would have to move in with her father.

So despite the heebie-jeebies that they give me, I haven’t attempted to revoke the DNR or my health care proxy. It boils down to a lesson you learn over and over again as a parent: It’s not about you.

stockmanSebastian Stockman has written for The Atlantic.com, The Kansas City Star and other publications. He lives in Cambridge, Mass., with his wife and daughter. 

 

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