Our Bioethics and Health Care Department is headed by Marnie R. Poncy, RN, Esq., a registered nurse and attorney, who spends as much time in hospitals and assisted livings facilities representing our clients as she does in the office or in court. Mrs. Poncy established the Bioethics Law Project http://bioethicslawproject.com/ as a pilot program for Palm Beach County and under County grant. The Project was a result of a study by the Robert Woods Johnson Foundation and Ms. Poncy’s assessment of the burgeoning local need to address issues of patient self determination in the event of catastrophic disease and with end of life care.
Health Care Advocacy
We have grown to meet the needs of our clients and their families. As clients age these needs evolve and change. We represent our clients as health care advocates, when they are confronted with decisions concerning their circumstances at hospitals and with assisted living facilities. Often complimenting this role and because money matters and family finances can be affected, our wealth management department (budgeting, tax and estate planning, and assistance with investment policies) also participates in planning related to our client health care needs and objectives.
Health care advocacy involves understanding legal rights as an attorney as well as whether health services are being delivered properly, in earnest, and with care. Backgrounds and expertise in both medicine and law are necessary to confront these issues. Often these issues are clouded by conflicts that may exist within the family dynamic. Properly accomplished, health care advocacy keeps the focus on you, as the patient, in your time of greatest need, rather than permitting the focus to shift to others.
Living wills, health care surrogate designations, and other advance directives are sterile documents, which unless personalized cannot address the exigencies that exist in hospitals. Furthermore, they often fail to consider the strain on family relationships which are exacerbated when sibling rivalries and self interest produce family conflicts.
Historically, the intent of living wills, health care surrogate designations, and other advance directives was to keep the courts away from what should be a very personal decision process. Advances in medical technology have prolonged life and, hence, quality of life for longer periods of time has become an increasingly important goal. Latent family dysfunction often comes to the forefront when subjected to the stress and tension of prolonged illness of a loved one. Family dysfunction is positively correlated with the length of time senior family members are incapacitated and therefore the possibility it can adversely affect the quality of life of a failing senior family member increases.
Palliative care is acomprehensive approach to treating serious illness that focuses on the physical, psychological, spiritual, social and existential needs of the patient. It is a statutory right under Florida law. The goal of palliative care is to achieve the best quality of life available to the patient through relief of suffering, control of pain and symptoms, and by enabling the patient to achieve maximum functional capacity. Respect for the patient’s culture, beliefs, and values are an essential component. Palliative Care is sometimes called “comfort care” or “hospice type care.” We have had to exercise our clients’ rights to proper palliative care when these rights are interfered with (sometimes trampled) by the health care industry and dysfunctional families.
With so many of our clients aging in Florida, and their families living busy lives up North, degradation of senior family member health can lead to guilt in junior family members: “I feel like I should be down there with Mom and Dad because they need help, but I have to pay my own bills and can’t just leave my family.” Changes of health may also lead to senior family members losing control of the family, where children begin to argue over control over not only family wealth but also over senior family member health care. Often this is a result of a lack of information and unbiased supervision- people tend to think the worse case is occurring: “I wonder if my brother is overreaching Mom and having her change her will? “ “I wonder if my sister is having Mom cancel that loan that was made to her to buy her home?” “I wonder if my brother’s control over Mom and Dad’s checkbook is being misused.”
We have seen our practice take on a reporting roll to family members, where they can gain a level of comfort that not only financial and legal affairs of their parents are in order, but that they are being properly looked-after and have proper care and surroundings.
Experience and Our Role
Our role is to assist our clients and their families preserve their wealth, live comfortable lives, and avoid family dysfunction. Often simple estate planning documents are all clients need to avoid family conflict, guardianship, and invasive intrusions into their lives, person, and property. Unfortunately, that is not always the case. With more and more use of assisted living facilities by clients, the services ALF’s offer have become more widespread and competitive. Facility contracts offer many options; facility staffing may not offer the qualities that are needed or expected; or negligence may occur or contracts may be breached.
Family problems caused by the mental health of a family member, mistrust, sibling rivalries, and fights over money are age old problems that are becoming more frequent. This can be directly linked and correlated with the aging of our society and the degree to which medical technology has prolonged life. As such, our services have evolved to include family mediations and interventions, serving as a trust protector, serving as a family arbitrator or mediator, or representing the interests of senior family members in guardianship or other legal proceedings. Growing to meet the needs of our clients has been facilitated by the trust clients have placed in us in serving their legal and related needs. We appreciate our relationships, which have allowed us to properly age with our clients.