Updated: Jan 6, 2022
This column first appeared in the San Antonio Express News and other Hearst newspapers on November 12, 2019.
Dear Mr. Premack: I have a question that I can't find an answer. If I have a do not resuscitate form filled out and signed, does that in any way, or can that in any way, disqualify my life insurance policy that I've had for a long time for my grandchildren and my son to receive payments as beneficiaries? Can they say my death was suicide because I made the decision to refuse intervention instead of allowing the costs (both emotional and financial) of dying to linger? -B.I.
Texas law allows a variety of ways for individuals to legally control their end-of-life decisions. As a group they are called “advance directives”. Let’s start by defining them:
1. A DNR (do-not-resuscitate) order may be made in the hospital or for an outside-the-hospital situation. It states that if you are found dead – no heartbeat, no respiration – your instruction is to be left that way, without efforts to resuscitate you. Out-of-hospital DNRs must follow a specific format provided by Texas law while in-hospital DNRs depend on each hospital’s own policies. Note that a DNR is the only backward-looking directive: it says, “after I die do not bring me back,” so it has no bearing on the cause of death for life insurance purposes.
2. A Directive to Physicians is your legally binding statement that, should you later be diagnosed with a terminal condition and lose the ability to communicate your instructions, everyone should default to providing only palliative care instead of providing artificial life support. It says, “get out of my way and allow me to die naturally.” This legal document must follow specific statutory guidelines before it is deemed legally effective.
3. A Medical Power of Attorney is your legally binding authorization for someone else to make medical decisions for you when you become incapacitated. Those decisions can include withholding artificial life support, creating a DNR for you, and foregoing other treatments even though death could result.
4. Texas does not allow Death with Dignity, but nine states and the District of Columbia do allow it. A Death with Dignity instruction is an election, when diagnosed with a terminal illness and still competent to make choices, for the patient to end their life to end their suffering.
The question, then, is: if you choose any of your legally available options, is your life insurance policy going to be at risk because of its suicide provision?
Suicide provisions in life insurance policies are designed to stop people from buying a bunch of life insurance right before they commit suicide. This discourages suicide as a “bail my family out of financial trouble” solution and keeps the life insurance companies’ statistical projections on track. They are, after all, in the business to make a profit. Even so, suicide clauses generally say the policy fails only if the suicide happens within two years of the purchase of the life insurance. Suicide does not void a life insurance policy that has been in effect for a longer period of time.
Further, Texas law specifically provides that signing or issuing an advance directive – a DNR, a Directive to Physicians, or a Medical Power of Attorney – cannot be used by a life insurance company to 1) refuse to sell that person a new life insurance policy, or 2) restrict an existing life insurance policy, or 3) invalidate the benefits payable upon that person’s death, even if death occurs after withholding or withdrawing life-sustaining treatment. You will not lose your life insurance because you have signed or eventually use an advance directive.
Texas does not allow Death with Dignity, but the states which do allow it to have legal provisions disallowing insurance companies from refusing to pay benefits when the law is utilized. For instance, Washington law states that Death with Dignity shall have no effect on a life insurance policy. The patient would have died soon suffering from the terminal illness, so the death is not legally the same as an otherwise physically healthy person ending their life by suicide.
Paul Premack is a San Antonio Certified Elder Law Attorney, handling Wills and Trusts, Probate, and Elder Law issues. View past legal columns or submit free questions on those legal issues via www.Premack.com.