Advance Care Planning

Portfolio Manager Neela White returns to the podcast to discuss advanced care planning, including:

1. What is it?
2. How do you start?
3. What to investigate?
4. Decisions to be made?
5. The conversation -with who?
6. Should you write it down?

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Transcript

Chris Cooksey: Hello, and welcome to the Advantaged Investor, a Raymond James Ltd. podcast, a podcast that provides perspective for Canadian investors who want to remain knowledgeable, informed, and focused on long term success. We are recording this on November the 13, 2023. I'm Chris Cooksey from the Raymond James Corporate Communications and Marketing Department, and today our friend, Portfolio Manager Neela White, returns to the podcast. As we discussed many times, Neela has an expertise focusing on the issues facing seniors and their caregivers, and today, Neela is going to discuss advanced care planning. Welcome back to the Advantaged Investor, Neela, I hope you're doing great and had a great weekend.

Neela White: Thank you, Chris. Thank you for having me again. And I did, I was just actually commenting, I actually saw my first little bit of snow on Saturday. So, so it's not all bad that the Christmas decorations are out in every store right now.

Chris Cooksey: Yes, I know my wife started saying, should we put the Christmas lights up? And then I think we threw all our Christmas lights out last year. And anyway, we'll have to buy new Christmas lights is the real point. Anyway, I'm glad you're doing well. Another important issue that should be discussed out there today, in terms of advanced care planning. So, let's just jump right in and we'll start off with a 10, 000 foot view as we usually do, what is advanced care planning?

Neela White: So advanced care planning in broad concepts is what are your wishes? So, it's a document that outlines your wishes for care at the end of life. The importance of it is there are many treatments that can be put in at end of life to either prolong your life or comfort measures in which case you can choose how you would like to die. So part of the importance of having an advanced care plan is not just necessarily for aging, but also for the unexpected. If something happened to you and you were unable to communicate your wishes, or you lacked capacity to communicate your wishes, really, would you want the doctors or your family to guess what it is you want, by writing it down it helps your loved ones guide your end of life.

Chris Cooksey: Right. Reminds me of sort of a will. Do you want the government deciding where your stuff goes?

Neela White: Right, and that's, that's actually a very good analogy. Do you want the government….

Chris Cooksey: You don’t have to sound surprised, Neela, that it was a good analogy!

Anyway, let's let's get, let's, and then that all makes sense. Of course. And So where do you start from?

Neela White: You know what, I think part of it is taking a step back and having, having a quiet reflection with yourself and thinking about what's right for you. What is it that you want? What are your values? What are your beliefs? And what's your understanding about end of life? I know a lot of people have this concept of, of what a good death is and what a good death isn't. And they're very fearful as opposed to our healthcare system is so developed right now that. It's it's much more than what we saw possibly happening to our parents. So I think it's one of those things we need to actually understand what our choices are for care at the end of life or medical procedures. If we choose to have intervention. I think it's. on us to learn about end of life options and procedures, especially depending if you were diagnosed with a terminal illness. Also part of the starting is you need to decide who's going to make those medical decisions on your behalf. If you're unable to speak or lack capacity to make those decisions. And then I think finally and possibly the most, one of the most important things is. You have to have this conversation with someone.

It can't just be a conversation or internal dialogue you have with yourself. You need to communicate that with your power of attorney for care or your substitute decision maker. It can't be the best kept secret. It's not fair to somebody who's left behind or has to decide.

Chris Cooksey: Right, makes sense. Now, a lot of different options are out there.

Yourself, you're a death doula, and that's a, I mean, I was aware of the doula during the childbirth process, but have recently[00:04:00] heard about death doulas. So there's lots of different options out there for individuals to consider. And I think the government, you know, is making or helping people to choose to end their lives in certain ways. That methodology is there now. So what, what are the things you should be investigating? Is it just, how do I want to go out for lack of better terms?

Neela White: So, so what are your options? And I think, where do you want to die? Do you want to die in the hospital? Most people, when surveyed, don't want to die in a hospital. They'd want to die at home. So, if you do want to die at home, what do you need to put in place to make sure that that can happen as peacefully and as well as possible. You need to make sure that plans are set in place. If you wanted to die at home, do you want to die in hospice? If you were terminal and you had a terminal prognosis, would it be hospice? Would you have to get in touch with the hospice? How much lead time do you need? So things like that. You need to investigate. And I think it's also important to, you know, [00:05:00] just even just do a Google search on medical interventions at end of life. So things like, do you want to be resuscitated? And if so, in what cases?

Do you want a feeding tube? Again, if so, in what cases? Do you want dialysis? And I think it's, it's knowing some of the terminology and maybe that's an idea for the next podcast is terminology terms to know, but it's also doing a bit of legwork on finding out, does it prolong my life well? Right. Is that something I want? Or does it prolong my life, period? Right. And I think those are very personal decisions, and because they're so personal and they're so emotional, it really is important and incumbent on us to be... You know, it puts us in a vulnerable position, obviously, but to have these conversations with people because if you're feeling that emotional about it and uncertain and fearful and scared, can you imagine the person who actually has to make the [00:06:00] best guess decision on, I think this is what mom wanted. I think this is what dad wanted. I think this is what my spouse wanted. That leaves a lot of guilt because you will never know if it was the right decision.

Chris Cooksey: And I guess this and as you mentioned, lots of decisions to be made, whether it's do not resuscitate. I know my grandmother had a, had a do not resuscitate and they did. And that doctor heard heard, heard an earful. This was a while ago, but you know, you get to make those decisions at the end of your life. So maybe what are some of the other decisions that have to be made?

Neela White: I think who, who is who is that person who is going to be your voice? Who's going to be your advocate?

Who do you trust to be able to advocate for you, even if it's not Okay, What did they want? Right. And I, and I think that can be where some of the issues happen. If you don't have these conversations with someone, let's say it's a decision just fundamentally they could not support, therefore not carry out in your best interest. Are they the best person just because they're your closest living relative or anything like that? So I think it's having the conversation to make sure that somebody is able to support and advocate for your end of life decision.

Chris Cooksey: You still need someone to help you manage the health care system.

Neela White: You need somebody who's going to be talking to the doctor.

You're going to need someone who possibly, if there's a lot of family with differing, differing opinions. Right. They're going to be the person who holds. The ability to make that decision and be your voice, so you need to make sure it's the right person. I've seen happen many times where, you know, even though parents have expressed their whole lifetime, you know, a certain fundamental belief in life that, because everybody has a different view at end of life when dying. That even though they know fundamentally that was the parent's decision, they will try everything to keep them alive as long as possible. That has to do with the person who's going to be left behind, not the person who's dying. And therefore, you know, having this document that helps support, this is what I want, makes it easier for the doctor to say, hey, look, it's quite clear that this is what Mrs. Smith or Mr. Smith wanted.

Chris Cooksey: Yeah, it's, it's always been, I mean, from my point of view you know, pets, you have pets, and, and, and at some point, maybe the dog can't go up the stairs anymore, the cat is sick all the time or whatever, and people out of, you know, they say, prevent suffering, we're putting the animal down, but sometimes we just don't do that with humans, and I don't mean to say, obviously put them down, that's an awful way to phrase it, but conceptually, you know.

We recognize in animals, we don't want them to go through certain things. But, and I get, I also understand humans are a level ahead of animals to most people, but it's just one of those confusing things around it. So, as you mentioned, a lot of conversation has to happen, both with the person who's looking out for you, or Probably better a couple people looking out for [00:09:00] you to, so there's a maintenance status quo or, or, or bounce the ideas off or prevent someone from doing something on their own.

So, you know, obviously you're talking with family, you're talking to your doctors, lawyers, perhaps anyone else you'd be talking to in this situation.

Neela White: You know what? I think family, I think, I think friends, as you mentioned, doctor, lawyer, I think also, you know, even a if you're dealing with somebody on the financial side, just so they're all aware that this decision making's in the process. And, you know, just in case there's, let's say you want the death to happen somewhere special, you know. Right. They can be part of the, of the support system. That way your family doesn't have to like, oh, you know, let's say you want to, let's say you want this to happen in Hawaii, let's say, and that's going to cost X amount of dollars, you know, did you put it aside planning for this so your family doesn't have to worry about it or even, you know, part of the [00:10:00] end of life, like, let's say what you would like is a A huge, huge, huge celebration of life and it's going to cost X amount of dollars because you want, you know, a live band and fully catered and whatever the special treatment that you want once you're gone is, let's say it is going to cost 25, Have you set it away that your family can honour your wish?

Chris Cooksey: Yeah, you don't want to put that on the next generation necessarily if it's going to be big, right? And again, it's just one of those things, like an organ donor make sure people know. Yes, absolutely. And now, I guess finally is this something you should write down? Is it an actual legal document?

Neela White: It's, it's not a legal document. It is a, a letter of best best wishes, a letter of this is what I want, respect me a letter of values. It is not a legal binding document, but it just really helps medical personnel and people that if there's any sort of. Debate on, well, no, dad didn't want this or dad didn't want this. Here's a document that was created by you expressing who and what you valued and how you would like your last days to be. So it becomes less of an emotional decision with, well, maybe you heard it wrong, maybe. That's not quite what they meant, as opposed to the document goes into quite a bit of detail about again, intubation, resuscitation what is a comfort measure, what do I consider a comfort measure, and stuff like that. So, it is super important to write it down because Words replayed in your mind aren't always, especially when you're under a large amount of emotional stress. You never replay it exactly the way it was, right? In which case, here's the document without, with emotion, but, you know, it's one dimensional. And it's less debatable.

Chris Cooksey: I also remember we were having our kids someone suggested we write down the birth story just because you're [00:12:00] never going to remember. So, you know, this is not like necessarily you write this out and you have two weeks. It could be years and years and years. So as those conversations can get lost or misinterpreted or evolve over time. So somebody,

Neela White: somebody knew, you know what, somebody new comes in your life. God forbid nefarious purposes. I want to keep you longer because alive. Sorry. I want your life to end shorter I want to keep you longer because of X Y and Zed so Writing it down and and giving a copy to someone I think is always a great idea that way.

There's a witness to it It is not a legal document. It is a document of intention of wishes of please honor me and what I would recommend if anybody gets it done is attach it to your power of attorney for care. So I have one. I got mine drafted just after my mom died. And it's attached to my power of attorney for care that way. If anyone had to make the decision and it was highly emotional and I'm assuming actually it's going to, it would be my daughter at a much later age that it wouldn't be. I can't do this. I don't know it's what mom wants and I don't want her to have that guilt on her. So here it is. Here it is in writing. I'm okay with it. This is what I want.

Chris Cooksey: I always appreciate you joining us, Neela. These are often heavy topics and you bring such a nice or a softer way of looking at it and and, and while at the same time keeping us focused on what's important. So thank you again for joining us and I know you'll join us again soon.

Neela White: Perfect. Thank you for having me today.

Chris Cooksey: Alrighty, reach out to us at the Advantage Investor pod at Raymond James. ca. Subscribe to The Advantage Investor on Apple, Spotify, or wherever you get your podcasts. Please contact your advisor with any questions you have. On behalf of Raymond James and The Advantage Investor, thank you for taking the time to listen today. Until next time. Stay well.

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