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You will never wind up in a coma.

It only happens to those poor souls on the nightly news. Or in the movies.  It’s never people like you.

Are you sure?

Last week, I updated my will and other end-of-life documents. It did make me stop and think about a lot of things. My money and possessions. My complex relationships with friends and family. My priorities. My health. My spiritual beliefs. Whether or how I want to live if the unimaginable happens. What people will think about me and my choices (although I guess I shouldn’t worry too much about it).

On the topic of coma and other “pull the plug” issues, my attorney recommended the Consumer’s Tool Kit for Health Care Advance Planning, compiled by the American Bar Association’s Commission on Law and Aging.

The documents in this kit are not legally binding. Instead, you use them to let your family, close friends and doctors know in advance what your personal medical preferences are.

There’s so much more to think about than just the generic coma situation:

  • Do you want to be an organ donor? (My answer: Yes)
  • If you have Alzheimer’s disease, do you want to be fed by a stomach tube? (My answer: No)
  • Would you be willing to endure the unpleasant side effects of chemotherapy if it could prolong your life? (My answer: Uncertain.)

You fill out the questionnaires, store them with your will and other documents, and tell your family where these important papers are. The kit also includes a “proxy quiz” to see if your family understands your preferences. If they don’t, now is surely the time to educate them. Bottom line: having your written instructions in hand may prevent unpleasant arguments later about your wishes in a variety of scenarios.

A True Coma Story

This anecdote is based on what happened to my friend “Steve” — I’m using a false name to protect his privacy.

While driving to work, he got hit by a truck and fell into a deep coma. The doctors couldn’t agree on his prognosis. No one knew what his future might hold. Family and friends were shocked. Saddened. Fearful. His wife was in denial. She was sure he was going to wake up and everything would be OK. He’d be the same guy who kissed her goodbye that Tuesday morning.

The day that changed their lives forever.

At a time of emotional devastation, his family had to consider excruciatingly difficult questions and the severe financial consequences. So put yourself in Steve’s flimsy hospital slippers and read on.

If He Dies

His wife would have to deal with the probate court, lawyers, relatives, friends, frenemies, banks, auto insurers, life insurance companies, employers, accountants, creditors and other interested stakeholders.

She’ll have to spend a lot of time, energy, and money to take care of all the paperwork. Does Steve have a will? If not, the process is much more complicated and aggravating, at a time when she’s busy grieving.

Do you have a will?

If He Doesn’t Die

Imagine Steve lives, but he is in a comatose state.

Had Steve ever told his family what he would want them to do in this type of horrible situation? Did he sign an advance directive to specify his wishes? Will his family “pull the plug” — or will he continue to live indefinitely in a suspended existence? Can they agree on what to do? If Steve handles the household finances, can his wife access the bank accounts and pay the bills while he’s unconscious?

The answers to these questions will direct the family’s financial future.

Medical Insurance

No matter what happens to Steve, there will be expensive hospital, doctor and other medical bills. Even if he has comprehensive medical insurance, it likely won’t cover all the expenses. He will have copayments and deductibles and all those things that aren’t explained too well in those Explanation of Benefits forms.

Major unexpected medical expenses like these often lead to personal bankruptcy.

Long-Term Care Insurance

You might think that you need this coverage only when you live in a nursing home at the end of the line (and you probably think you won’t wind up there, either).

However, suppose Steve wakes up and has significant brain or physical damage. He cannot feed or dress himself.  Someone has to help him get out of bed and go to the toilet. He may need extensive assistance at home from outside providers for the rest of his life.

Long-term care insurance may help pay for rehabilitation and physical therapy. That is, if he has a comprehensive policy that covers his expenses.

And I think most people do not have long-term care insurance. Do you? If you decide it is appropriate for your circumstances, don’t delay. The older you are when you apply, the higher the initial premiums.

The Household Finances

Steve may recover, but not enough to work again. His wife has a full-time job and she can’t stay home to take care of him. This sudden and drastic reduction in their income would have a catastrophic effect on the household budget.

They may not be able to afford to send their daughter to college. His wife may have to delay her retirement indefinitely, perhaps forever.

The “E” fund

You know how every personal finance expert on the planet tells you that you should have an emergency fund? Well, guess what. This is a bona fide emergency with a capital “E.”

Steve’s wife may need to exhaust those funds to pay not only for the medical expenses, but for everything from renovating their house to accommodate his disabilities to paying for daily parking at the rehabilitation center.

How much is in your emergency fund? You do have one, right?

So What Happened to Steve?

Against all medical predictions, my friend miraculously regained consciousness. He woke up from the coma.

Everyone is amazed and relieved that he is relatively functional. However, Steve has severe short-term memory loss. Imagine the agony, for example, of losing your car keys every 20 minutes, all day long. Every day.

It doesn’t matter, because Steve can’t drive. In fact, it’s not safe for him to be alone in the house for more than brief periods. He will never work again. Even with a comprehensive health insurance policy, he ran up outrageous medical bills.

We’re all thankful that Steve survived, but fearful about his family’s immediate and future financial situation.

You Need to Plan for the Future You Can’t Expect

I know what you’re thinking: “Well, too bad for your buddy Steve, but it won’t happen to me.”

Maybe.  I hope not. However, it’s wise for you and your family to take some basic steps now to address end-of-life and incapacity issues. These tasks are never pleasant. Stop skipping them on your to-do list.

There’s plenty of information you can find online, but please consult an attorney. Sign a combination of basic documents including a will or trust, an advance directive, a general durable power of attorney, and a healthcare power of attorney. Your lawyer can advise what will best suit your needs.

As tempting as it may be, I suggest that you don’t download form documents from the Internet. Each state has different rules. A simple mistake like not having your will witnessed or notarized properly could make it invalid. Don’t take the cheap route for something so important.

Also, please make sure that the people you care about sign a will and other documents and tell you their preferences.

The Cold, Hard Truth

I’ll always remember the last time I saw Steve before his near-fatal accident. I was driving him and his wife to a friend’s wedding. It was such a happy time for all of us.

No one knew that a ride in a car just a few months later would alter the course of their lives forever.

Of course, Steve did not intend to create such a big mess. And I hope you don’t think I am being callous by calling out the financial side of a serious personal drama.

However, most of us live in a bubble of protective denial, thinking that disasters only strike other people.

Don’t add economic destruction to the emotional devastation if such a trauma were to happen to you. Take care of yourself and those you love. Get your medical, legal and financial papers in order.

What would happen if you were in a coma?

Image: marcosmartinezromero

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