Phinney Estate Law has long been an active part of the NW LGBT Senior Care Network.  We wanted to make sure everyone knew that the group is now part of Sage Seattle. 

The group is a great resource for information on caring for LGBT Seniors and has a wonderful list of providers who have shown their commitment by signing up and signing a comprehensive non-discrimination policy.  For information, like them on Facebook.

One question that we often get asked about organ donation is "if I sign up as a donor will doctors be less likely to work to save my life?"  The answer is absolutely NO!  This is an urban myth that prevents a lot of people from signing up to be organ donors.

The reality is that that the medical team treating you is completely separate from the transplant team that would evaluate your organs to see if they are viable.  The treatment team is dedicated to your recovery and governed by the decisions of your health care agent or proxy.

Moreover, in order for a person to become an organ donor, blood and oxygen must flow through the organs until the time of recovery to ensure viability. This requires that in order for a person to be an actual organ donor they must die under circumstances that have resulted in an irreparable neurological injury, usually from massive trauma to the brain such as aneurysm, stroke or automobile accident.

Donation is only considered after all efforts to save the patient’s life have been exhausted, tests are performed to confirm the absence of brain or brain stem activity, and brain death has been declared. 

Another frequent question we get about Organ Donation is:

Aren't I too old to donate organs?

Many clients are joking when they ask but the misconception that their is an age limit for donation leads many who can and would be donors not to take the steps to volunteer. 

While there are diseases such as cancer and AIDS that prevent donation, there is no age limit on donors.  As doctors we have worked with have explained, if you have a critical organ failing that is difficult to match, the healthy organ of an 80 year old that is a decent match is going to be much better than what you have.  Matches at that age and above are not uncommon and save lives.  So don't write off your organs yet!

If you have more questions about organ donation, or are interesting in making your wishes regarding donation known and included in your disability and estate plan, contact us for a free 1/2 hour consultation.  We can be reached at (206) 459-1908 or [email protected].

One issue that we encourage all clients to address is their Advanced Health Care Directive is whether or not they are willing to be an organ or tissue donor.   As a result we get a lot of questions and wanted to try to answer some of the most common here including:

How Needed is Organ Donation?

As of July 2012 there are currently 114,712 Patients Waiting for life saving organs.  Of those, 64,292 are Multicultural Patients who can be especially difficult to match and 1,737 are Pediatric Patients.  Each day, 13 of them will die because the organs they need have not been donated. Every 16 minutes, a new name will be added to that waiting list.

The good news is that 28,535 Organ Transplants Performed in 2011 from 14,144 Organ Donors.  In addition, more than 46,000 corneas were transplanted in 2011.

Long wait lists result from low rates of opt in to the donation process, the special circumstances required to allow organ harvesting, and the difficulting in finding safe matches for some patients. 

If you have more questions about organ donation, or are interesting in making your wishes regarding donation known and included in your disability and estate plan, contact us for a free 1/2 hour consultation.  We can be reached at (206) 459-1908 or [email protected].

In our last post we gave recommendations about treatment choices that are helpful to add to an advanced health care directive.  But working with families in the middle of health care emergencies we know that those are not the only choices agents get asked to make.  So when working with clients on their advanced health care directives I encourage them to give guidance as well such as:

o   I want my doctor to give me enough medicine to relieve my pain, even if that means that I will be drowsy or sleep more than I would otherwise.

o   I want my doctor to give me enough medicine to relieve my pain, but I want my pain medication reduced frequently to allow me moments of lucidity.

o   I want my Health Care Agent to explore alternative medicine treatments.

o   I want to be kept fresh and clean at all times.

o   I want to have personal care like shaving, nail clipping, hair brushing, and teeth brushing as long as they do not cause me pain or discomfort.

o   I want to have people with me when possible.  The visitors that would be most meaningful to me are: ___________________________________________________________________________________

o   I want to have my hand held and to be talked to when possible, even if I don’t seem to respond to the voice or touch of others.

o   I also want to have religious readings and well-loved poems read aloud when I am near death, such as: __________________________________________________________________________________

o   If I am alone and awake I would like to have music or books on tape playing, such as: __________________________________________________________________________________

o   I want to have pictures of my loved ones in my room.

o   I want to have flowers or live plants in my room.

o   I want to have a hospice care and other palliative care provided as soon as appropriate..

o   I want to be treated at home if possible.

o   I want to have the members of my faith community told that I am sick and asked to pray for me and visit me.

o   I want to have others by my side praying for me when possible.

o   I do not want to have politicians or clergy involved in my health care choices

o   I do not was clergy visiting me.

We have had clients select a host of mixtures of these instructions.  Often selecting them can feel strange, especially if the client is currently healthy.  It can feel controlling or demanding.  But the reality is that we have never had an agent tell us they had too much information about what they do.  What makes the job hard and encourages conflict is the agent and others involved not knowing what the right thing to do is for that specific patient.

If you would like help drafting an Advanced Health Care Directive that is right for you, contact us for a free 1/2 hour consultation at (206) 459-1908 or [email protected]

In prior posts we have discussed that one of the benefits of using an attorney to draft your estate plan is the freedom to add details about your wishes that aren't available in the forms provided at hospitals.  We find these details make a world of difference when agents are trying to make choices in a crisis. 

When drafting ADHCs for our clients we introduce them to four treatment philosophies that are well understood by medical professionals:


Active Treatment:  This category of care includes all reasonable medical attempts to extend life.  This would include resuscitation, intubation, surgery, dialysis, feeding tube, antibiotics, and other interventions. 

Treatment without Resuscitation: Same as above but without allowing resuscitation.

Trial Treatment for 30 Days:  Active treatment for 30 days.  After 30 days, if there is no improvement or increased hope for improvement, treatment is changed to comfort care only.

Comfort Care: Treatment to relieve symptoms and improved quality of life including pain medication.  No treatment done solely for the purpose of extending life. 

We then ask them to say which treatment philosophy they would want their agent to use in the following examples:

Condition 1: Permanent Unconscious Condition

An incurable and irreversible condition with no reasonable possibility of recovery from a vegetative state. It involves the complete destruction of the higher structures of the brain, but not the brain stem. People in PVS can breathe. Heartbeat, lung function, and other biological functions continue. They can appear awake.  They cannot communicate, make voluntary motion, and are not meaningfully aware of the world around them.  They require a feeding tube to survive.

Condition 2: Coma

A state of profound unconsciousness in which an individual is incapable of sensing or responding to external stimuli. 

Condition 3: Terminal Condition with Unmanageable Pain

An incurable and irreversible condition caused by injury, disease, or illness, that would within reasonable medical judgment cause death within a reasonable period of time, usually six months, in accordance with accepted medical standards, and where the application of life-sustaining treatment would serve only to prolong the process of dying and where pain cannot be adequately managed without rendering patient unconscious.

Condition 4: Advanced Dementia Neurological Damage or Alzheimer’s

An incurable and irreversible condition caused by injury, disease, or age that destroys memory and impulse control. Advance stage is marked by major personality changes and an inability to recognize family or friends.

We also ask them if there are any other conditions or symptoms they would want addressed. Many clients have professional experiences or experiences with family members that have led them to have strong preferences about certain types of treatment and these can always be added. 

While the situations above will not cover every medical emergency that might require an agent to make choices they give a good guide to allow them to at least think my analogy and provide guidance for many more questions than the just feeding tube or no feeding tube kind of question in the hospital forms.

If you would be interested in creating a detailed advanced health care directive for yourself, contact us to schedule a free 1/2 hour consultation at (206) 459-1908 or email us at [email protected].

In previous posts we have discussed how to select and document your choice of who should serve as your Health Care Agent if you should loose the ability to provided informed consent for your own health care choices.  That is without a doubt the most important single step you can take in make a plan for your future possible medical disability but there are other steps that can and should be taken as well and one of the most important is drafting an Advanced Health Care Directive.

An Advanced Health Care Directive, as the name suggested, provides guidance to your Health Care Agent and Doctors about what kind of health care choices you would want made for you in difference circumstances.  These documents are often referred to as "living wills."   In Washington the statute that allows for the creation of Advance Health Care Directives is RCW 70.122.  The statute requires that the directive be executed while the agent is still capable of make their own health care choices and be witnessed by two witnesses who are not close family members or health care providers.  The statute also places restrictions on the application of Advanced Health Care Directives when patients are pregnant.

Many hospitals have free Advanced Health Care Directives that address a few limited forms of life support but much more detailed directives can be done with an attorney and the more detailed guidance is usually much more helpful to families.  An attorney can also make sure that the witness rules are followed as forms provided in hospitals are often witnessed by inappropriate witnesses that can render them invalid. An attorney can also ensure that added language is put in the directive to make it effective in other states that have different execution requirements.

If you would like to schedule an appointment to develop an advanced health care directive contact us for a free 1/2 hour consultation at (206) 459-1908 or [email protected].

FAQ: Does my Health Care Agent need to be local?

There is no legal requirement that you health care agent be someone who lives near you.  However, filling that role long distance can be a challenge so finding someone who lives nearby is always a plus.   But location is just one factor among many.  

When considering distance it is important to remember that the real issue with distance is how quickly they could be at the health care facility interacting directly with the doctors providing your care and giving meaningful directions.  Factors for that could include travel time but might also include how much notice they would need to leave their job and family responsibilities in a crisis.  A single sister with a flexible job in San Francsico might be a better bet on that front that a single mom with young children in Pasco who can't get off work without several weeks notice. 

It is also important that you don't let this factor alone trump all the rest.  It should be the best person serving in this role not only the closest.  If in doubt, it is possible if working with an attorney to have an interim agent appointed who can serve until the best agent can be at the care center.  That might be a local friend or family member who could be in communication with the permanent agent and be gathering information and making imminent decisions until the agent can really assess the situation on their own. 

If you have questions about how to select and assign the best health care agent for your unique situation, please contact us for a free 1/2 hour consultation at (206) 459-1908 or [email protected].