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Monetary Considerations

By Roger C. Bone, MD, reprinted with permission

Page One of Two Pages

In Reflections: A Guide to End of Life Issues for You and Your Family, distributed by the National Kidney Cancer Association, this chapter is entitled "An Early Frost." Dealing with a weakening body as you face your last days, months, or years is hard enough. You don't want to also deal with the additional burden of a less than optimal financial situation for you and your family. Fortunately, the ideas in this article will point you in the right direction to get the help you may need.

Incidentally, in our Chronic and Serious Illness section, we have the Five Wishes health care directive that is accepted in 35 states and the District of Columbia. It will give you a good idea of how you can make it easier for your family to know your wishes concerning health decisions. If nothing else, it will give you a chance to reflect on what you really want.

A terminally ill person does not need convincing that a will is a good idea. However, writing or updating a will may be one of the first psychological crises faced by you and your family. A patient in the early stages of the disease naturally holds out some hope for recovery, particularly if he or she is able to function normally and is relatively pain free. The family, as well, will be optimistic. As a result, considering the idea of devising a will may cause you to become discouraged and deeply depressed. It is as though everyone has suddenly given up or accepted your prognosis before the illness has naturally defined itself. It is understandable to put off decisions that in and of themselves feel "accepting" or in "anticipation" of death.

Monetary decisions, in general, deeply affect the terminally ill. Finances connote a cold and calculating image, which is often devoid of any emotion and can devastatingly reduce a long and complex life to a single column of black numbers on white paper. Almost a hundred and fifty years ago in Victorian England, Charles Dickens symbolized the vacuousness of financial affairs in his description of an inheritance lawsuit in the opening pages of Bleak House. "Jarndyce vs. Jarndyce" had existed so long in the courts that all the original participants, including the attorneys, had long since passed away as the case proceeded through the system. In other words, finances often take on their own bleak life and have a numbing effect on the human spirit.

Financial questions can also create great stress if the terminally ill person is the primary provider for his or her family. First, how will your spouse and/or children survive? Even if you own a substantial insurance policy, what are the long-term financial implications for the family? How far into debt will the illness drive them before the patient dies?

Perhaps the terminally ill person is also the family money manager. This personal job will have to be transferred in a similar manner to your work position, as I described earlier. The process can be tedious and time-consuming and, no doubt, will lead to discussions about past practices and future procedures. Your spouse, parents, or children may be unpleasantly surprised by the family's pecuniary condition. The problems can range from total financial upheaval to not being able to find such items as past tax records, which can help determine the fiscal status of the family. Total communication with all parties involved in your estate is important. For example, what good is an insurance policy if other members of the family know nothing about it?

Deciding who will inherit your belongings is often at the heart of family disputes both prior to and long after your death. No family can be perfect or plan for every foreseeable crisis. You might think your estate is settled and your wishes recognized; however, one of your survivors may change his or her mind about what to keep from your past. For instance, it may be mutually decided that your daughter inherits the antique writing desk while your son will receive the beat-up car you drove to work. No problem-until your daughter concludes, suddenly, that she wants the car instead. You may be beyond caring, but this unplanned dispute over the car can be a major inconvenience for the living.

Careful financial and estate planning can solve problems and arrange limited resources for maximum benefits. It can mean the difference between a loving resolution for the person who is ill and a prolonged grieving process confused with financial bitterness for the family. It is crucial that one must start early, seek help when appropriate, and make certain everyone who has a stake in what happens is informed. Not telling your nephew Charlie that he is the Executor of your estate until the day before you die is not prudent management.

It is beyond the scope of this book to provide a complete guide to the financial implications of dying. Individual circumstances will dictate what type of decisions need to be made and your viable options. However, what follows is a general guideline that may serve as a checklist.

The Will

A will is a statement concerning what should be done with your possessions and financial assets after you die. It need not be complicated or even drawn up by an attorney. However, it is usually advisable to involve one. If you feel you cannot afford a lawyer, look up the number of your local legal aid society in the phone book and call them. Depending on your income and personal assets, you may be able to have a will prepared for free or at minimal cost. Individuals with multiple investments or a complex family structure, such as a spouse from a previous marriage or multiple children, will require professional legal assistance.

It is crucial you complete the will before you become critically ill. Putting it off may lead to questions later concerning your mental status at the time of its preparation. Objections could surface retrospectively as soon as you begin medical treatment, especially if it involves potent drugs such as pain medication or chemotherapy.

A side benefit, and not an insubstantial one, is that the terminally ill patient will discover his or her assets and/or possessions in the process of gathering information for the will itself. One may uncover forgotten resources, such as insurance policies and designated beneficiaries. Organizing and accumulating the family's financial affairs will hopefully improve the patient's self-confidence as he or she faces the cost of medical treatment.

Power of Attorney

One mistake families and patients make is waiting to authorize a power of attorney. Keep in mind this decision should be made while you are in complete control of your mental faculties. If the designation of power of attorney is stalled until it becomes absolutely necessary, the legality of the transfer of authority could, in fact, become questionable.

The duties of the person who has been given power of attorney range from writing checks, authorizing bill payments, and overseeing estate expenditures from your trust to serving as the contact person for nursing services and other medical organizations. He or she will assume total responsibility for the financial decision making after you have become impaired or incapacitated. Be open with friends and family members when considering your options. One can designate a spouse, a child, or a trusted friend to oversee these matters.

Terminally ill patients must contemplate, therefore, not only how they want their assets dispersed but also who will be the one to execute their financial goals. This person needs to be competent in addition to being able to work well with both you and your family. If you designate someone in whom you and your family have trust and confidence, you will also provide a great amount of relief for everyone involved.

CONCLUDED on Page Two

© Copyright 1997, National Kidney Cancer Association