The recent death of Casey Kasem made me think about how things can still go wrong even when we believe that we have prepared for the inevitable.
Casey Kasem, a popular radio host, recently passed away at age 82. Many of us remember him as the voice of “American Top 40,” a weekly radio show on which Casey read listener dedications while counting down the hits. The listener dedications were emotional tributes to a loved one, often choking me up.
Although Casey retired in 2009, he made headlines in the months leading up to his death as his family fought about his end of life care. The battle arose between Casey’s children and his wife, their stepmother. Casey was suffering from Lewy Body dementia, a progressive brain disorder. He had also developed sepsis, a life threatening infection. His children wanted to discontinue Casey’s treatment, while his wife, Jean, fought for continued treatment. Both sides claimed their method was what Casey would have wanted. Eventually, Casey’s daughter was appointed guardian for Casey and, as guardian, she had his treatment discontinued. Casey died a few days after.
Sadly, this is not the first time we have read or heard about a family at odds over end of life treatment for a family member who no longer has capacity to communicate his or her wishes.
Usually, this happens because the individual in question had not created what we refer to as advance directives. Advance directives include a Living Will and a Healthcare Power of Attorney (POA). A Living Will provides instructions to the healthcare providers about our treatment preferences if we are at end of life and unable to communicate our wishes. A Healthcare POA appoints a surrogate to communicate our treatment preferences to the healthcare provider.
However, this was not true in Casey’s case. Casey had created a Healthcare POA naming his daughter as his agent or surrogate decision-maker. So why couldn’t Jean, his wife, follow her husband’s wishes regarding his end of life care?
First, let me say that I do not have personal knowledge about Casey’s family or their motivations for making claims about what he would have wanted. However, I do think that many times the problem is communication—specifically a lack of direction from the person creating the documents. We create documents, appoint surrogates to speak for us, and we think we are done. The surrogate will “know” what we would want. After all, dying is not a pleasant topic, especially if the prospective death is ours. But family members don’t always know what we want. If we haven’t had the discussion about our values and preferences if choices must be made toward the end of life, the person we selected to be our surrogate will have to guess.
Casey did appoint his daughter to make healthcare decisions for him. But did he tell her, or for that matter his wife, what he would want or not want done? Both sides claimed he wanted the opposite. Were their claims based on knowledge, grief, or some other motive? I don’t know, but I would like to believe that if Casey had told his family what his preferences were for end of life care, they would be more likely to follow his wishes.