In preparing a full estate plan for clients, we always walk through the process of drafting health care powers of attorney and living wills to be prepared for the possibility of a medical crisis in which the patient/client is unable to speak for himself, and to direct loved ones how to proceed when the patient/client is facing the end of his life. The standard language directing doctors to provide “comfort care” or avoid “artificially delaying the moment of death” with which the medical community is most familiar usually makes sense and feels appropriate for most people. The challenge for many clients lies in understanding and feeling comfortable with what it means to a doctor that a person is in an irreversible, incurable, or persistent vegetative state, presenting a scenario in which the directed action should be taken.
A client told me about the JFK Coma Recovery Scale, a 23-item assessment tool to assist doctors with developing diagnosis, determining prognosis, and planning treatment for patients suffering from brain injuries. This scale is widely accepted in the medical community in discerning differentiating states of consciousness, and for accuracy in identifying varying states of awareness. A study referred to in The Economist indicates that many neurologists prefer to rely on their intuition rather than a scale in determining degrees of awareness and cognition among clients, which in a notable number of cases may result in inaccurate diagnoses.
A directive to doctors to use this scale may provide greater peace of mind to clients trying to be prepared for the wildly unexpected and wanting reassurance that the most clear and reliable diagnosis has been made. On the other hand, this scale may determine that a patient is “minimally conscious”, rather than in a “persistent vegetative state”, and thus in a condition that may only marginally improve with rigorous and extensive rehabilitation. Many clients may not feel that the improvement that might be achieved would render their life desirably livable, and might prefer to pass on quickly rather than linger in a compromised medical condition.
Regardless of one's personal wishes, the availability of this tool as an option to guide medical treatment is something all clients should be aware of and give some consideration to including in their advanced medical planning.