The Honolulu Star-Advertiser has featured several stories by reporter Dan Nakaso about the plight of Karen Okada. Karen is a 95-year-old woman who signed a “Death with Dignity Declaration” and a “Durable Power of Attorney for Health Care Instructions” back in 1998. Both documents purport to control “in all circumstances.”
The Queen’s Medical Center has determined that Karen is essentially brain dead, or, in any event, has “permanently” lost the ability to participate in medical treatment decisions, and that the provisions of her Death with Dignity Declaration now require that her feeding tube be withdrawn.
On the other hand, Karen’s healthcare agent, in consultation with doctors who are not associated with Queen’s, disagrees with the hospital’s physicians. What the agent knows, and the Queen’s physicians discount, is that just before she was hospitalized, Karen was conscious and able to interact meaningfully with her family and caregivers. During the time she has been at Queen’s with pneumonia, Karen has been unresponsive during examinations, but she has smiled at least twice at her adult grandchildren and nodded to her grandson in response to his question of whether she was able to breathe freely.
The policy of Queen’s is to give precedence to an advance healthcare directive over a durable power of attorney in all events, and without inquiring into why a person may have signed contradictory documents. Accordingly, Queen’s sued Karen’s healthcare agent in order to get a court order forcing him to order that Karen’s feeding tube be removed.
Since no one would want to be part of this kind of drama, what can you do to make your wishes clearly known so there will be no questions?
1. If you do not have an advance health care directive, get one. Make sure your loved ones, including your children over the age of 18 have one too.
2. Learn all you can about the options that can be written into your advance health care directive. These are not “one size fits all” documents. Your wishes may differ greatly from those of your friends and family members, and the document you sign should express your particular desires.
3. If you have an advance health care directive that is more than 5 years old, there is a good chance that it will not accomplish what you think it will. Review it right away with your legal counsel. Make any appropriate changes and updates.
4. If you want to give a trusted family member or friend the power to make health care decisions for you, make sure the power of attorney meshes well with any other instructions.
5. Be sure to give your health care providers your permission to give your medical information to your family members or other trusted decision makers. Federal and state privacy laws restrict your doctor from talking with your health care agent unless you grant that permission.
6. Review your advance health care directive periodically to make sure it accurately states your current wishes. Once per year is not too often.
7. Make sure you have a mechanism in place for giving you access to your advance health care directive, no matter when or where an emergency might occur. Not all health problems happen at home, and if you have a crisis while you are traveling, you will need a way to make your health care documents accessible to your caregivers.
8. Talk with your family about your wishes before a crisis arises. Make sure everybody is on the same page. If your decision makers indicate hesitation about carrying out your wishes, think about naming someone who will. Your assurance to your loved ones of how seriously you intend your instructions to be taken will give them the courage to carry them out.
Knowledge is power. The more you know about advance health care directives, the more likely it will be that your wishes will be carried out.
Scott Makuakane, Attorney at Law
Specializing in estate planning and trust law.
www.est8planning.com
O‘ahu: 808-587-8227, Maui: 808-891-8881
Email: maku@est8planning.com




This fall, I hope you will exercise your right as an American to vote on November 6th. Generations Magazine has Linda Coble to thank for our flag-waving cover story, as she is one of my favorite ladies, community leaders, and I am honored to call her my friend. We’d also like to thank Principal Shannon Goo of Lincoln Elementary School for allowing us to shoot the magazine’s cover on campus, as my son Zachary and his schoolmates had a blast. If you need some inspiration to vote this year (or general voting information), turn to our cover story, Make Your Voice Count.
In order to keep your immune system strong, you need to eat a nutrient dense diet rich in antioxidants and anti cancer phytochemicals, which only come from fruits and vegetables. This soup is packed with just that. Kale, bok choy, onions, garlic, mushrooms, zucchini, carrots, and red bell pepper are all micronutrient rich foods that protect us from disease. The beans add a good source of healthy protein and fiber that we need on a daily basis. Feel free to add any other vegetable or other types of beans you may like. It makes a good amount so you can freeze some for later. Know you’re getting everything your body needs to stay healthy and live strong.
Slice vegetables onto a foil tent, pour 3-4 Tbsp. of olive oil over them and toss. Add cilantro, sprinkle with Italian seasoning and pressed garlic cloves. Toss again. Close tent and roast on the grill for 30 minutes. If roasting in the oven, bake at 475° until vegetables are tender.
The Kokua Council is one of Hawai‘i’s oldest advocacy groups. Kokua Council empowers seniors and other concerned citizens to be effective advocates in shaping the future and well-being of our community. The Council encourages those needing help in advocating for themselves.
Annual membership is $10.