Difficult Conversations Prior to Treatment

Written by: Heather Vasek | Brains for the Cure Ambassador

After a diagnosis of brain cancer, it is likely that surgery or some other treatment will be recommended to remove or shrink the tumor. These treatments can sometimes alter a patient’s mental status and/or ability to communicate. This possibility makes it all the more important for families to consider executing various legal documents to ensure that a patient’s wishes are honored. While it may seem morbid to discuss what treatments or measures should be taken to keep someone alive or comfortable, these documents can help provide guidance and reassurance for both families and patients that decisions are being made with the patient’s interests in mind. The language and content of these documents can vary depending on state laws, so please be sure to discuss with the patient’s health care providers and/or attorney about what choices are available in the patient’s state and what forms need to be completed. If these documents are not executed, state laws can vary as to who is allowed to make decisions on the patient’s behalf, which factors are considered in providing treatment or care, and how decisions are made about a patient’s care. 

Medical Power of Attorney allows you to designate person(s) to have the authority to make health care decisions for you when your physician certifies that you are unable to make these decisions on your own behalf. This is often used following surgery or when someone is unconscious or comatose until the patient is able to make decisions on their own behalf again.  

The person the patient chooses to make health care decisions on their behalf when they cannot is called the “agent.” Any competent adult can be the agent unless they are

  • The patient’s physician or health care provider 
  • An employee of the patient’s physician or health care provider (unless the employee is their relative) 
  • The patient’s residential health care provider (a nursing home for example) 
  • An employee of the patient’s residential health care provider (unless the employee is their relative) 

The patient should choose someone they trust to act according to their wishes and has good knowledge of their wishes (including their values, religious and moral beliefs), and agrees that their medical choices are in the patient’s best interest. The patient’s parents or spouse can be an agent, but the patient can also choose other family members or friends. A Medical Power of Attorney can be changed or canceled at any time, but only by the patient. 

Durable Power of Attorney gives the patient’s agent the authority to make financial decisions and usually does not give the person the right to make decisions about health care. The patient can designate different agents for a medical power of attorney and durable power of attorney. 

Living Will is a legal document that tells others what the patient’s choices are about end-of-life medical treatment. It specifies the procedures, treatments, or medications the patient wants—or doesn’t want—to prolong their life. These treatments can include being put on a ventilator, a feeding tube or intravenous fluids, and pain medications.  

A living will is different than a medical power of attorney because it specifies which procedures, treatments, or medication the patient wants under which circumstances to prolong or continue their life, while a medical power of attorney gives authority for the agent(s) designated by the patient to make decisions on their behalf which are generally not addressed or specified in a living will.  

Do Not Resuscitate Order (DNR) is a legally binding physician’s order stating that no steps will be taken to restart a patient’s heart or restore breathing if the patient experiences cardiac arrest or respiratory arrest. These steps typically involve cardiopulmonary resuscitation (CPR), which is not always successful and can come with risks of injury or brain damage. State laws can vary on what these orders look like in a hospital or nursing home compared to when a patient experiences cardiac arrest at home so please discuss with the patient’s treating physician. 

A Will is a legal document that describes the patient’s wishes regarding the distribution of their property, assets, possessions, and money, and the care of any minor children. Having a will can be especially important if the patient has a domestic partner to whom they are not legally married and they want that person to inherit or receive any property or possessions, or want them to care for any minor children. If the patient dies without a will, a court will make decisions about who will receive the patient’s property, assets and possessions, and who will care for any minor children. This can cause conflict among family members. The patient can prepare a valid will themselves without a lawyer, but the document should be witnessed to reduce the likelihood of the document being challenged later. 

After a diagnosis of brain cancer, a lot of important decisions need to be made by the patient and their family. Preparing these legal documents can help alleviate the stress and burden of making these decisions in a crisis and can ensure the patient’s wishes are honored. 

This article is for informational purposes only and does not constitute legal advice. Please consult with your attorney and health care providers for additional guidance on how these documents can be used. 

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