Dying Tax Free: The Modern Advance Directive and Patients' Financial Values

• Published in: Journal of pain and symptom management Vol. 39; no. 3; pp. 605 - 609
• Main Authors: Kirk, Timothy W., PhD, Luck, George R., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2010; Elsevier
• Subjects: advance care planning; Advance Directives; Aged, 80 and over; Anesthesia & Perioperative Care; Biological and medical sciences; clinical ethics; Decision makers; Decision Making; Ethical dilemmas; ethics; Female; Humans; living wills; Medical sciences; Pain Medicine; Palliative care; Palliative Care - economics; Palliative Care - ethics; Palliative Care - legislation & jurisprudence; patient values; Pharmacology. Drug treatments; Shock, Septic - therapy; Taxation; Taxes - economics; Taxes - legislation & jurisprudence; terminal care; Terminal Care - economics; Terminal Care - ethics; Terminal Care - legislation & jurisprudence; Treatment preferences; wills; decision making; Advance directives; terminal care; ethics; living wills; advance care planning; palliative care; patient values; clinical ethics; wills; Human; Decision making; End of life decision; Care; Ethics; Palliative care; Planning; Public health
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2009.12.003

Abstract Advance directives are often used to help patients articulate their end-of-life treatment preferences and guide proxy decision makers in making health care decisions when patients cannot. This case study and commentary puts forth a situation in which a palliative care consultation team encountered a patient with an advance directive that instructed her proxy decision maker to consider estate tax implications when making end-of-life decisions. Following presentation of the case, the authors focus on two ethical issues: 1) the appropriateness of considering patients' financial goals and values in medical decision making and 2) whether certain kinds of patient values should be considered more or less relevant than others as reasons for expressed treatment preferences. Clinicians are encouraged to accept a wide range of patient values as relevant to the clinical decision-making process and to balance the influence of those values with more traditional notions of clinical harm and benefit.