When your clients know their date of death

With the assent of Bill C-14 in 2016, advisors will increasingly serve clients who choose medical assistance in dying. Here, a financial planner, a lawyer and a funeral director discuss working with clients who proactively plan for death.

In 2017 financial planner Steven Sorko worked with a long-time client and friend who had decided to end her life with a physician’s assistance.

The woman, who had terminal cancer, “wanted to go out on a high,” says Sorko, a CFP and CPCA with HollisWealth, Investia Financial Services Inc. in North Vancouver. She didn’t want, he said, to put herself or her family through what could be a potentially long and painful process.

Working in tandem with his client’s lawyer and accountant, Sorko helped her liquidate and pay taxes owing on her investments and then gift them to her children, thus removing them from her estate and bypassing probate. The client wanted to die at home, and so had made the decision not to sell her condo before her death—but the place was spotless and ready for the realtor (engaged in advance) to show within days of the death. She disposed of or passed on her personal belongings, closed several bank accounts, cancelled subscriptions and wrote an obituary, which Sorko posted on Facebook within a couple of hours of being notified of her death.

“Because she was open about the process, we were able to make financial decisions that saved money for her children, and to liquidate and reduce her estate very quickly,” says Sorko. “Things that normally would’ve taken a month took days.”

Throughout, says Sorko, the client retained a sense of humour about the process. “The day before her planned death, she cancelled her cellphone. The Telus employee asked why, and she said, ‘Well, I’ll be dead tomorrow.’ There was this long silence on the other end of the phone until the person stammered, ‘Well, have a nice day,’ and hung up.”

Kavina Nagrani, an estates and elder-law lawyer in Toronto, has acted on behalf of a half-dozen or so clients who have chosen medically assisted death.

“They tend to be very calm and confident in the decision,” says Nagrani, an associate at Loopstra Nixon in Toronto. “They don’t want to have to live the way they’ve been living any longer. And now they’re looking for ways to minimize their estates and get their last wishes on paper.”

These cases tend to be time sensitive, says Nagrani, both because the date of death is often imminent and because of concerns the client could lose the mental capacity to make the decision to enact death—for example, by slipping into a coma, experiencing a medical event like a stroke, or having a disease like cancer or Alzheimer’s progress to the point where the person is incapacitated. (To be eligible for medically assisted death, patients must be capable of making the decision to die at the time of death.) For that reason, she says, lawyers and advisors who want to be effective advocates for their clients who have chosen assisted dying have to be able to prioritize those clients above all others.

It also often means witnessing clients at their most frail, often in hospice or hospital. “Typically,” says Nagrani, “these people are very sick. You don’t know what physical state they’ll be in when you get there. And that can be difficult emotionally, although it’s harder on the family members than on me as a lawyer. Showing a certain amount of emotion humanizes you as an advisor—it helps ease the situation. But it’s also important not to be more emotional than the client and the family.”

Kat Downey is a Mississauga, Ont.–based licensed funeral director who specializes in prepaid funeral plans. In 2017 she dealt with three funerals that resulted from medically assisted death. “One son came in on a Monday to say his mother would be in on Tuesday. It totally caught me off guard.”

Downey admits that she struggles with the concept of assisted death. “On one level I do understand when a person has had enough and doesn’t want to carry on or continue treatment,” she says. “But personally, could I do it? I don’t think so.”

Still, she says, she respects her clients’ wishes and sees discussions about assisted death as a needed opportunity to educate clients about the estate-planning steps they can and should take to smooth the processes before and after death.

Sorko supports the legislation fully. “From a professional point of view, I think it’s a good thing. From an emotional point of view, I see a lot more contentment and relief from the people organizing their affairs.”

He recalls another client who battled cancer for years. “She wanted to fight for as long as she could, with the option of a physician-assisted death as a last resort. She didn’t want pain.”

When the woman, in her 80s, was approved for medically assisted death, says Sorko, “It was like a revelation. When the doctors signed the paperwork, her mood shifted completely. She became much more pleasant, happy and positive, knowing she had that out.”

Like Nagrani, Sorko believes the regulations around assisted death need to be more flexible. In particular he believes the provisions that require people to be able to consent up to the moment of death are unnecessary and even cruel. “If you’re in a coma, or if you have advanced Alzheimer’s, and you can’t say that you want to die, you’re hooped. And that can lead to weeks or months of agony, expense and turmoil for you and your loved ones over something that you had legal permission to do.”

Estate-planning professionals face questions of life and death every day, which may better equip them for cases of assisted dying. “We already have the skills to deal with it,” says Nagrani. “This is what we do.”

Still there are always new skills to learn. For example, what do you say to a client at the end of your last meeting before the date of their planned death? “I struggled with that question the most,” admits Nagrani. All the usual options—See you later, Best wishes, Good luck—seem inappropriate for the situation. Going into her first such meeting, she hadn’t yet settled on an approach.

In the end she went with her gut. “I took the client’s hand and I said, ‘It was lovely to meet you.’ I said, ‘I’m very glad that I was able to help you, and I want you to know that you can call me any time, night or day, if you need anything else.’”

Assisted dying: Requirements for approval

To be approved for assisted dying in Canada, clients must:

• be Canadian residents
• be at least age 18
• be capable of making decisions both at the time of the request and at the time of the intervention
• make a voluntary request
• give informed, express consent, and
• have a grievous and irremediable condition, which means:
  • a serious and incurable illness, disease or disability at an advanced stage of irreversible decline
  • the condition causes physical or psychological suffering, and
  • natural death is reasonably foreseeable

Different provinces and territories have different processes and requirements. Clients should talk to their physician or nurse practitioner about end-of-life care options.