Tag: End of Life Planning
Other than the last name of Denis Shapovalov (Canada’s newest rising tennis star), one of the most difficult pronunciations I’ve come across lately is pharmacogenomics – a form of personalized medicine that could be a game-changer in terms of linking the right drug to the right person to improve their health outcome.
Like Shapovalov, it’s a name worth remembering. Pharmacogenomics involves laboratory testing of a person’s DNA to determine gene variations that can predict how a person will respond to medications. Test results can identify which medications will be effective, avoiding the use of medications that would have little or no effect, or many side effects.
For example, there are many medications available to help treat depression, but these drugs can take several weeks to take effect and for a person to feel any improvement. And in many cases, after several weeks, there is no improvement, so the individual is weaned off the first drug and on to the next choice. In the meantime, the person continues to suffer, valuable time is lost, and there’s no assurance that round two will go any better. An effective medication may be found eventually, but months or even years could go by.
Had the individual been introduced to the right medication from the start, they would have been spared months of suffering. In many cases, that’s what pharmacogenomics can provide.
Pharmacogenomic testing is done with a simple cheek swab, and lets a doctor prescribe medications more precisely based on an individual’s DNA.
Toronto-based health care provider Medcan says that while there are many factors that affect our responses to drugs – such as height, weight, gender, and age – anywhere from 20% to 95% of the variation in how a person responds to medication can be directly linked to genetic differences, and specifically the differences in how they metabolize a given drug: http://www.medcan.com/medcan-insights/workforce-wellness/reduce-disability-absenteeism-costs/.
For example, if a person is a fast metabolizer, he or she may need more of a given drug or more frequent doses; if he or she is a slow metabolizer, lower doses of a drug may be necessary to avoid an overdose.
And this is not a “one day we’ll be living on Mars” future possibility. This type of testing is happening right now. In fact, it may be coming to a pharmacy near you soon. The B.C. Pharmacy Association has already conducted trials with an Australian genetic testing company: http://www.benefitscanada.com/benefits/health-benefits/pharmacogenomic-testing-to-be-available-in-pharmacies-across-canada-93665.
As estate litigators, we’re used to dealing with “end of life” issues. It’s nice to find a simple test that can enhance “quality of life”, while we’re here to enjoy it.
Thank you for reading … Enjoy the rest of your day.
Life expectancy has unsurprisingly been on the rise over the course of the last several decades. You would think with the superior quality of life many currently experience that there is hope for more people to live up to 100 and beyond. After all, the Guinness World Record for the longest living person is held by Jeanne Calment, who died in 1997 at age 122!
However, Ms. Calment’s status as a supercentenarian is a rarity. Even more exceptional is her living into her 120s. No one else has been verified as doing so. Further, it was recently reported that researchers calculate 115 to likely be the maximum life-span. Without a breakthrough that fixes age-related problems, the new research apparently indicates that living beyond this age is not probable.
Some geneticists disagree, taking the view that as there has been success in extending the life and health of certain laboratory animals, the same may be achievable for humans. With technological advances may come innovations that will meaningfully impact longevity.
The debate about whether this is achievable is expected to continue. Nonetheless, we know that people are generally living longer and, coupled with this, will have more pressure on their financial resources, as well as the increased likelihood of mental decline. So I believe it to be prudent to encourage our clients to seek the appropriate professional advice on how to plan for a longer retirement or an extended work-life, as well as for coping with cognitive impairment. Some suggestions with respect to the latter include:
- appoint your Powers of Attorney(s);
- make a Will;
- designate beneficiaries on your bank and investment accounts;
- have life insurance in place;
- simplifying your finances (e.g. consolidate accounts);
- create an inventory of assets; and
- perhaps most important, communicate with your family.
Thanks for reading and have a great weekend,
Last week, I wrote about the recent trend of Death Cafes. As a reminder, a “Death Cafe” is a place for people to gather and discuss death with others, often strangers, over tea and cake. The goal of the Death Cafe is provide a space for people to speak about death, which is a taboo subject for many. Because of this taboo, people often avoid speaking about their own death to their friends and family. This reluctance to think about and speak forthrightly on the subject of death might prevent people from creating an effective estate plan. The Death Cafe can act as a forum for individuals to get more comfortable with the concept of dying and planning for the distribution of their assets upon death.
The current trend is to host Death Cafes among strangers, but it is worth thinking about holding a death cafe with loved ones. One major problem in succession and estate planning is communication. As mentioned in The Family War, a major point of tension between families in an estate battle is that they did not communicate and gauge their family member’s intentions prior to their death. Holding a family Death Cafe would provide an opportunity for families to avoid a large amount of fighting and grief in the future.
The Death Cafe website has some helpful information about how to hold a death cafe. They suggest avoiding an overly structured session, instead allowing the conversation to find its direction by allowing everyone to say what they want to say first. After this free-form conversation, whoever is facilitating the death cafe might introduce some specific questions. This would be a good time to address specific expectations and wishes regarding the will or funeral arrangements. In hosting a death cafe among family members, some topics to touch on might include what to expect after losing a family member, how to prepare for loss, possible sources of support and guidance, and avenues of communication for close and more distant family members. By creating an open platform and place for communication, some family turmoil might be avoided.
The Death Cafe website has helpful resources including checklists, conversation topics, and a blog.
Thank you for reading.
When most people think about the term “midwife”, they probably think about someone who has been specially trained to assist an individual throughout pregnancy and in giving birth. While this certainly is the classic definition of a “midwife”, it appears that the term may no longer exclusively apply to those who assist at the earliest stages of life, but also perhaps to those who assist in life’s final stages as well. As recently reported by the Toronto Star, a group in British Columbia has self-stylized themselves as “death midwives”. Their purpose? To assist individuals in their final stages of life.
While the group has received some resistance for utilizing the term “midwife” in relation to their work, the actual sentiment behind their work appears to be unchallenged. With the recent enactment of assisted dying legislation in Canada, the previous stigma surrounding discussions regarding end of life care may be lifting, and people may begin having more open and honest conversations regarding how they would like to die.
The rise in the use of the term “death midwife” or “death doula” has been reported for some time, with the CBC having done a feature on the practice last year. As discussed in such a feature, the use of a “death midwife” can allow for a healthy dialogue for an individual in confronting their own mortality, helping them to avoid their “nightmare scenario” of their own death. Death midwives can help create “death plans”, and assist with social and psychological support throughout what otherwise could be a very difficult process. Once the individual is deceased, they can also assist the family with vigils and funerals, and assist to guide them throughout the immediate aftermath of the individual’s death.
Have a great weekend.