Casey Kasem, famed radio DJ and actor recently endured a very traumatic (and public) end-of-life journey.
The icon's odyssey began in early May, 2014, when his second wife, Jean, removed him from a Santa Monica nursing home, where he had been placed due to his Parkinson's and advanced Lewy body dementia. First, Jean drove him 300 miles away to Las Vegas, then to Arizona, before returning to Vegas. The pair then took off on a 900-mile private plane ride that landed 82-year-old Casey in an airport in the state of Washington, five days later. An ambulance eventually transported Casey to a single family home, where he stayed until he was finally admitted to the hospital on June 1, 2014.
Casey's three children from his first marriage--Kerri, Julie and Mike--were largely unaware of their father's whereabouts after he was removed from the nursing home. The ongoing fued between Casey's adult offspring and Jean had come to a head a few months earlier, after she attempted to sever their visitation rights to their father.
However, in the days following Casey's disappearance, the court granted temporary conservatorship to Kerri. The next few weeks dissolved in series of legal battles over Casey's medical care. The celebrated media personality passed away on June 15, 2014, after he was placed on "end-of-life" measures by his family, despite Jean's protestations.
What can we learn from Casey's case about the impact of conflicting health care directives?
One lesson might be to engage in family conversations about end-of-life issues sooner, rather than later, and use the many tools that are available to help plan for a health care proxy.
A long-time coming
The problems that led to Casey Kasem's final journey didn't develop overnight.
According to the Hollywood Reporter article "The Sad, Strange Family Battle Over Radio Legend Casey Kasem," Casey met his second wife Jean in 1980, when he was 47 and she was 24. From day one, there were relationship problems between Jean and Casey's three children from his previous marriage.
The Hollywood Reporter quotes daughter Keri Kasem as saying her father told her:
"It's going to get better, I promise." Unfortunately, things never got better.
Advance planning tools for families
The American Bar Association (ABA) has compiled the "Consumer's Tool Kit for Health Care Advance Planning," that features ten separate "tools" families can use to make the planning process simpler and more effective.
Tool number one helps adults compare candidates for their health care agent or proxy by outlining the factors to keep in mind. For instance, one factor to consider is the person's ability to handle conflicting opinions between family members, friends and medical personnel. Another factor on the list is whether your health care agent "can be a strong advocate in the face of an unresponsive doctor or institution."
Keeping an agent's power in check
In 2007, after he was diagnosed with Parkinson's disease, Casey signed his first health care document, naming his middle daughter, Julie, and her husband, Jamil, as co-health care agents. Julie is a physician assistant and Jamil is a UCLA Medical Center cardiologist.
That first document mentioned that their agency was "Subject to any limitation in this document." But the limitations mainly had to do with end-of-life decisions, with little being said about Casey's care before death was imminent.
In my state, Massachusetts, the Health Care Proxy Law gives you the option to list exceptions to the powers of a health care agent. So, if you knew in advance that members of your family might disagree on something to do with your care and treatment, you could write in some exceptions to the authority of the health care agent.
At first, you might think only of medical treatment exceptions. But couldn't these exceptions express other wishes and preferences, such as geography?
For example, you could say that your agent has no authority to transfer you to a nursing facility more than 30 miles from your hometown. You have a better chance of identifying these special circumstances by consulting with an estate planning and elder law attorney, who can take the time to talk with you about what's important to you and your family.
Speaking honestly and clearly about end-of-life wishes
You can hear how weak Casey's voice was becoming by July 5, 2009, when he recorded the final American Top 20 Countdown. The Hollywood Reporter says it took Casey eleven hours to get through the recording of that final show.
Two years later, on April 13, 2011, Casey signed a second health care directive. This document names Casey's wife, Jean, as his sole health care agent. Written into the document was the same power for Jean to sign discharge papers for "Leaving Hospital Against Medical Advice," which had been written in the first health care directive Casey signed in 2007. But this second document also gave Jean the power to "restrict my visitors" if "my agent determines that a visitor is distressing me or interfering with my treatment."
The ABA tool kit includes conversation scripts that encourage you to talk about what you want your agent to do. "No matter what your advance directive says, others will not fully understand your wishes. The more thoroughly you communicate, the easier it will be for everyone to respect your wishes." Thinking about what you want, and writing it down while you still have the ability, can provide evidence of what you really want if there is a conflict in the future.
Whether your family relationships are stable, strong, broken or somewhere in between, times of declining physical and mental health are guaranteed to bring about grief and emotional uncertainty that put a strain on family members who are called on to cooperate and act in your best interest.
You give them the best chance to rise to these challenges by preparing explicit instructions for them, including a health care proxy, as well as the tools they'll need to use the power in the proxy document the way you want them to.