The Honolulu Star-Advertiser has featured several stories about Karen Okada, 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.”

In mid-2012, shortly after Karen was admitted to The Queen’s Medical Center for treatment for pneumonia, the doctors at Queen’s determined that Karen was essentially brain dead, or, in any event, had “permanently” lost the ability to participate in medical treatment decisions. Accordingly, Queen’s wanted to enforce the provisions of her Death with Dignity Declaration and withdraw the feeding tube that had been surgically placed in Karen’s side more than six months before she was admitted to Queen’s.

On the other hand, Karen’s health-care agent (her brother), in consultation with doctors who are not associated with Queen’s, disagreed with the conclusions reached by the Queen’s physicians. What Karen’s agent knew, and the Queen’s physicians did not find relevant, was that shortly before she came down with pneumonia, Karen was conscious and able to interact meaningfully with her family and caregivers. During the time she was at Queen’s, Karen was unresponsive when doctors examined her, but she reportedly smiled at least twice at her adult grandchildren and nodded to her grandson when he asked her whether she was able to breathe freely.

Although Karen breathes on her own, she has to do so through a tube that was inserted into her windpipe. At some point in time, her family hopes the tube can be removed, which will enable Karen to eat normally. In the meantime, Karen has to be fed through a tube that goes through her side and into her stomach.

Because Queen’s policy is to give precedence to an advance health-care directive over a durable power of attorney in all events, and because Queen’s believed that the terms of the directive required removal of Karen’s feeding tube, Queen’s sued Karen’s brother in order to get a court to order that Karen’s feeding tube be removed.

After delays in the court process, Queen’s relented and to allowed Karen to be placed in another facility with her feeding tube intact. As subsequently reported in the Star-Advertiser, Karen’s condition improved to the point where she could once again interact meaningfully with her family members and caregivers.

In the meantime, Karen and her family experienced a drama that no one would want to repeat. So what are some steps that you can take to spare yourself and your family from being the characters in a similar story?

  1. Get an advance health-care directive, and make sure your loved ones have them too.
  2. Make sure your advance directive and power of attorney work together to express your wishes clearly.
  3. Give your health-care providers permission to give your medical information to your trusted decision makers. Otherwise, privacy laws can restrict your doctor from talking with your health-care agent.
  4. Have a way to get access to your advance directive. You never know when or where an emergency might occur.
  5. Talk with your family about your wishes BEFORE a crisis arises. Make sure everybody is on the same page, or at least clearly understands your wishes.

Knowledge is power. Learn all you can about advance health-care directives, and put that knowledge into practice. You will make things much easier on yourself and your family when you do.


Scott Makuakane, Attorney at Law
Specializing in estate planning and trust law.

Scott’s TV’s show on KWHE, Oceanic channel 11: Malama Kupuna airs Sundays at 8:30pm
O‘ahu: 808-587-8227, Maui: 808-891-8881