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End-of-Life Lessons of Bobbi Kristina's Tragic Death

By Nick Tate   |   Friday, 31 Jul 2015 09:37 AM

Bobbi Kristina Brown’s tragic death offers a number of poignant end-of-life lessons for parents, young adults, and seniors alike.

First and foremost, health and legal experts say Brown’s death spotlights the need for establishing written advance medical directives as early as age 18. These include the designation of a healthcare proxy, a living will, and a “HIPAA Release,” clearing the way for a healthcare designate to communicate with providers about the care of a patient who is in a coma or otherwise incapacitated.

Such planning is typically viewed as a concern for older Americans, but younger people — like Brown — can also find themselves unable to communicate their end-of-life wishes as a result of accidents, brain injuries, infections, and other illnesses.

David Netburn, an attorney who specializes in estate planning and healthcare-related legal matters in Coral Springs, Fla., notes 18 is the “age of majority” — when a young person is generally considered an adult — in Florida and other states.

“I do not believe that parents can still give informed consent as legal guardians once the child reaches 18,” he tells Newsmax Health.

“Accordingly, I think it important for the parents of any college-bound freshman (18 and older) to consider having a healthcare designation, a living will, HIPPA release, and durable power of attorney prepared for the ‘new’ adult. That way in the event of an emergency the parents can act on behalf of their kids.”

Brown, 22, the only child of singers Whitney Houston and Bobby Brown, died Sunday, following a six-month saga during which family members battled — often publicly — over how to treat the comatose woman after she was found face-down in a bathtub in the suburban Atlanta townhome she shared with her boyfriend Nick Gordon.

Fernando Gutierrez, a bioethicist and registered professional patient guardian, tells Newsmax Health Brown’s case spotlights the difficulties families face when confronted with such complicated healthcare decisions and praised the young woman’s relatives for their thoughtful handling of her situation.

“This is a good case study, the reason being is you have a young patient …who was on life support for 6 months, then on hospice since June,” says Gutierrez, who has specialized training in clinical healthcare ethics and patient consultations.

“I would make the argument that the parents followed the protocol I would recommend — giving [Brown’s] body a chance to recuperate, so she may have a miracle and give her a chance to live. And I believe they made a decision [to remove her from life support] with sufficient moral certitude and I thought it played out perfectly.”

Like Netburn, Gutierrez strongly urges establishing advance medical directives to ease the way for family members of patients like Brown. Such end-of-life instructions should be put into a legal document, usually prepared by an attorney to be sure it meets the requirements of state laws, which vary.

Such directives include:

A healthcare designation. This is the most important element of an advance directive: Crafting and signing a “healthcare designation” or “healthcare proxy” naming an individual authorized to make medical decisions for you, if you can’t do so on your own.

Such individuals, who do not need to be relatives, are given what are sometimes referred to as durable healthcare powers of attorney (POA) that grant them the authority to speak on your behalf. In designating a proxy, make sure to consult the person ahead of time, and share your decision with other close relatives or friends.

A HIPPA release. This document — short for the Health Insurance Portability and Accountability Act — clears the way for your proxy to communicate with your healthcare providers about your care. HIPAA is a medical privacy statute that bars doctors from discussing details about a patient’s medical history and care without authorization.

A living will. This formal statement details your wishes for medical care if you end up in a “persistent vegetative state” — from which there is virtually no chance of recovery — and you are unable to communicate. Each state has its own regulations for living wills.

Treatment restrictions. It’s critical to detail, as specifically as possible, the circumstances under which would you want to have life-sustaining care or simply allow for nature to simply take its course. You should also make sure to give copies to your doctor, family members, and (if appropriate) close friends. Specific treatments you might address:
  • Do not resuscitate (DNR) order. This document spells out that you do not want providers to perform extraordinary measures, such as cardiopulmonary resuscitation, if your heart or breathing stops.
  • Mechanical ventilation. When, and for how long, would you want a mechanical respirator to take over your breathing?
  • Nutritional assistance. If the only way you could be fed is through an intravenous or stomach tube, at one point would you want such nourishment to be discontinued?
  • Dialysis. Kidney failure is often the first step toward death in terminal patients. When, and for how long, would you want to receive this treatment?
  • Brain death. Would you choose to simply be allowed to die, if your brain function was deemed minimal or immeasurable?
  • Organ donation. Do you have any wishes about donating your organs and tissues for transplantation?
End-of-life planning is a difficult topic to discuss, which is one reason just 26.3 percent of U.S. residents have completed advance directives, according to a 2013 study published in the American Journal of Preventive Medicine based on national surveys involving nearly 8,000 Americans.

But as the Brown case illustrates, it’s important to raise the issue — with spouses, family members, partners, adult children, and parents. One way to open up such a dialogue: Print out this article and walk through the specifics of an advance medical directive.

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The tragic death of Whitney Houston and Bobby Brown's only child offers many poignant end-of-life lessons. Among the most pressing: The need to craft written advance medical directives as early as age 18, experts tell Newsmax Health.
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