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Estate Planning
 
Estate planning has traditionally focused on minimizing estate taxes and directing the disposition of your assets after death. Yet, in today's modern world, managing your affairs has become even more complicated as issues involving health care and personal finances, which can arise during your lifetime, have become increasingly more important.

Consider what would happen if you were to suffer a catastrophic illness or become incapable of managing your own affairs. This situation could occur either through a long, gradual process, such as a deteriorating medical condition, or through a sudden and unexpected accident or illness. If such an event were to happen, who would make your important legal, financial, and health care decisions? On what authority would this individual act? 

Fortunately, there are some estate planning tools called advance directives that can help in dealing with these contingencies. 

Legal and Financial Decisions
A durable power of attorney grants authority to another person to make legal and financial decisions on your behalf in the event of mental incapacity. The powers granted can be broad or limited in scope. Some decisions a durable power of attorney can assist you with include your personal finances, insurance policies, government benefits, estate plans, retirement plans, and business interests.

Health Care Decisions
In the area of health care decision-making, you may recall the Karen Ann Quinlan case. In 1979, the New Jersey Supreme Court granted permission to her family to disconnect Karen's respirator, which her doctors believed was prolonging her life in a vegetative state. The case led to the enactment by various states of Natural Death Act Declarations (i.e., living wills).

A living will generally allows you to state your preferences prior to incompetency regarding the giving or withholding of life-sustaining medical treatment. In most states, you must have a "terminal condition," be in a "persistent vegetative state," or be "permanently unconscious" before life-support can be withdrawn. The definition of these terms and the medical conditions covered may vary from state to state. 

A health care proxy allows you to appoint an agent to make health care decisions on your behalf in the event of incapacity. These medical decisions are not limited to those regarding artificial life-support.

Advance directives by durable power of attorney, living will, or health care proxy are generally inexpensive, easy to implement, and should be considered essential estate planning tools for all individuals, regardless of age. In the absence of such documents, court intervention involving a great deal of time, expense, and possibly stress to your family, may be necessary to carry out your legal, financial, and health care wishes at precisely the moment when timeliness and ease of action are of the greatest importance.



 Historically, estate planning has focused on the minimization of taxes and the disposition of one's assets at death. However, managing one's affairs in the modern world has become more complicated, and quality of life issues (involving health care, finances, and how critical planning decisions are made) are becoming more important.

Consider what might happen in the event of catastrophic illness or incapacity. How, and by whom, would important financial decisions be made? How, and by whom, would important health care decisions be made? Such an event could be either a long gradual process (e.g., a deteriorating medical condition) or something which happens precipitously (e.g., a serious accident). Estate planning tools that can provide instructions for certain lifetime contingencies are called advance directives.

One mechanism that can provide for financial decision-making is a power of attorney. This agreement, entered into voluntarily, grants authority to another person to make legal decisions on one's behalf. The person to whom the authority is given is called the attorney in fact (generally must be an adult) who can act as the principal's surrogate or agent. The powers granted can be broad or limited in scope, depending on the desires of the principal (the person granting the power), and can include such areas as insurance transactions, estate transactions, investment decisions, government benefits, and retirement plan decisions.

Making the Document Binding
There are two aspects critical to assuring maximum benefit from setting up a power of attorney. First, the principal must have sufficient mental capacity at the time the document is drawn to make it binding in law. This means that the individual must understand the nature and effect of the document, much the same as required for other legally binding documents.

Second, if you want to use a power of attorney in the event of incapacity, the document must be a durable power of attorney. A durable power of attorney will remain in full force even upon subsequent mental incapacity of the principal. While this may seem obvious (the document remaining effective when it is most needed), it was not long ago that a power of attorney terminated upon incapacity. Now, all 50 states have statutes providing for a durable power of attorney. The expressed language must convey the idea that the powers granted in the document will not be affected by the principal`s subsequent disability.

In most states, there is a presumption that a power of attorney is not intended to be durable unless specific "durable" language is included. Additionally, state requirements can vary, making familiarity withindividual state statutes important. For example, Florida restricts who can be the attorney in fact, limiting the designation to a close blood relative. Some states also require that the document be witnessed or notarized. Not all states recognize a springing durable power of attorney (discussed below).

Choosing a Trigger Mechanism
Sometimes, the principal may want to have the power of attorney take effect only if and when mental incapacity occurs. In such a case, a springing durable power of attorney can be used, which becomes effective only upon the occurrence of a specific contingency (e.g., certification by a physician that management of one's financial affairs is no longer possible).

A springing durable power of attorney assures that the principal will not be relinquishing important rights while still able to make independent decisions. In crafting a springing durable power of attorney, the method of determining the triggering event (e.g., defining mental incapacity) should be carefully spelled out. (For example, relying on a court determination of incapacity would defeat one of the benefits of using a power of attorney, namely, avoiding court intervention.)


A durable power of attorney is generally inexpensive, easy to implement, and should be considered an essential estate planning tool for all individuals, regardless of age. In the absence of such a document, court intervention (with the accompanying time and expense) may be necessary to carry out one`s financial desires at precisely the moment when facility and timeliness are paramount.



Part I of this series looked at the durable power of attorney as an estate planning tool to direct financial quality of life decisions, designating an agent to act on one`s behalf when one is no longer able to do so. 

However, there are other issues which may be just as important as financial decisions, revolving around what kinds of health care measures will be taken (to alleviate suffering or prolong life) if one is incapacitated.

How, and by whom, such health care quality of life decisions will be made can be addressed using additional advance directives: living wills and health care proxies.

First, Some History
In the area of health care decision-making, you may recall the Karen Ann Quinlan case. In 1979, the New Jersey Supreme Court granted permission to the Quinlan family to discontinue Karen's respirator which her doctors believed was prolonging her life in a vegetative state. This case led to the enactment by various states of Natural Death Act Declarations (i.e., living wills). 

More recently, in the Nancy Beth Cruzan case (1990), the U.S. Supreme Court affirmed that a person's right to refuse treatment is guaranteed by the Constitution, but held that individual states had the right to determine the criteria for providing or withdrawing life sustaining treatment. (Nancy Cruzan, permanently incapacitated from an accident, had discussed her feelings about prolonging life with family and friends, but had not committed her thoughts to writing. Missouri required clear and convincing evidence--i.e., a written document.) The Quinlan and Cruzan cases suggest that instructions of a formally appointed health care agent must be followed, provided such directives are consistent with individual state guidelines. While definitions vary from state to state, over 40 states now have living will statutes, allowing individuals to provide instructions regarding life sustaining measures in the event of a terminal illness, including (in some states) coma or persistent vegetative state. 

Also, in 1991, the Federal Patient Self-Determination Act was passed, requiring all Medicare and Medicaid health care providers to inform recipients of their rights (under various court decisions and state statutes) to accept or refuse medical treatment, and of the right to set up advance health care directives.

Living Wills vs. Health Care Proxies

A living will is a set of instructions for a health care provider, stipulating the extent to which measures should be taken (consistent with state statutes) to maintain one's life, should incapacitation render the person unable to express his or her wishes. A health care proxy (also called a health care power of attorney in some states) appoints an agent to make any and all health care decisions, in effect implementing instructions, on one's behalf in the event of incapacity (a life threatening condition, or where the individual is unconscious and a treatment decision must be made).

Since the health care proxy grants decision-making power to a surrogate, its scope is broader than the living will which simply states a person's wishes in the face of terminal illness. The documents may be drawn separately, or the living will may be incorporated into the health care proxy, depending on state law. Both directives come into play only when the principal is unable to make health care decisions for him or herself.

Up until that point, the individual maintains decision-making authority with respect to health care. Usually, an individual can change or revoke both directives at any time. Some states have also enacted Default Surrogate Decision Making Statutes which define a priority of individuals who are empowered to act on behalf of a person who did not execute advance directives prior to incompetency.

Into the Future

These quality of life issues have become further complicated by the controversy surrounding the physician-assisted death movement and ongoing "Death with Dignity" voter initiatives. (One particularly important unresolved issue which could affect the use of living wills is the definition of "suicide" for insurance purposes.)

Despite such controversies, not only are one's personal wishes at stake, but also the potential emotional and financial burden placed on family members by a medical condition with no hope of recovery. Advance directives can allow an individual to maintain autonomy, while providing specific instructions to assure that his or her wishes are carried out to the fullest extent possible.

3040 Post Oak Blvd Suite 400, Houston, TX 77056
Phone: 281-220-2700 Fax: 713-968-0125 Email: rray@wealthdesigngroup.net

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