Originally published on Advisor Perspectives on February 6, 2017

I used to think end-of-life discussions were fairly straightforward. All that was involved was ensuring my clients had a will and a health care proxy. I couldn’t have been more wrong.

These are very challenging times. Historically, the primary justification for fees was the ability to add value by managing an investment portfolio. But this has become more of a commodity, with the advent of robo-advisors and hybrid advisors like Charles Schwab and Vanguard, who compete directly for retail business, at a sharply reduced fee.

Financial planning is the next area likely to meet the same fate. There’s no end to the financial planning software available to advisors. It’s only a matter of time before similarly sophisticated software will be accessible directly by clients from easy-to-use platforms.

What’s left?

There’s one area where you can add value – and where even the most sophisticated software cannot succeed. It’s largely ignored and often misunderstood. It’s also a subject few want to confront, which is why you can play such an important role.

End of life is complex

I used to think end-of-life discussions were fairly straightforward. All that was involved was ensuring my clients had a will and a health care proxy.

I couldn’t have been more wrong.

Most people have an idealized vision of how they want to die. They would like to be at home, surrounded by friends and family, without pain and die quietly.

The reality is very different.

According to an article in the New York Times, 50% of patients will die in hospitals “tethered to machines and feeding tubes” or in nursing homes. I’ve never met anyone who wanted to die that way.

You can have a major impact on your clients and their families by asking the following questions:

If you get a serious diagnosis, how aggressively do you want to be treated?

Clients should be aware that predictions by doctors are often overly optimistic. According to Nicholas A. Christakis, in his book Death Foretold, when doctors provide a prognosis, they are only correct about 20% of the time. They err on the side of optimism.

I am aware of a number of situations where patients in their 70s had advanced cancer and were told there was a statistically small possibility of surviving for five years with aggressive treatment. In each case, the quality of their remaining life was destroyed due to the pernicious side effects of chemotherapy. They died within a year. In retrospect, they would have been better off avoiding treatment and treasuring the time they had left.

Do you want the option to end your own life?

As of January 23, 2017, five states have enacted legislation permitting “death with dignity.” In these states, eligible individuals can legally obtain medications from their doctor to end their own life, on their own terms.

For religious and ethical reasons, some patients will not choose this option, which begs the question: Are they aware they have a choice?

It’s your job to be sure they know the facts.

Where do you want to die?

The quick reaction of most people will be “at home.” However, discussions with hospice nurses have given me another perspective.

I want to stay at home – and be pain-free – for as long as possible. But I also don’t want to be a burden on my family. Few families have the ability to deal with patients at the very end of their lives when the patient experiences symptoms indicating death is at hand.

I also learned that dying patients often don’t want to die in front of their loved ones. I‘ve heard many stories where the patient waited until everyone left the room for a few moments. When they came back, the patient had died.

Hospice care (either in-home or at a hospice facility) has many benefits. You should explore this issue with your clients.

This is a difficult subject for everyone. Few families will initiate it without outside intervention. If you want the satisfaction of adding immeasurable value, you will be the one to do so.