The Ethical Obligation to Plan for the Unexpected: Creating a Professional Will and Naming a Practice Executor

For therapists in private practice, the therapeutic relationship is built on trust, empathy, and a commitment to patient well-being. But what happens if the therapist is suddenly incapacitated or dies unexpectedly? Such situations can leave patients feeling abandoned and grieving, families overwhelmed by administrative burdens, and colleagues scrambling to manage the fallout. The professional obligation to plan for such events is both an ethical imperative and a critical element of responsible practice management.

In this post, I’ll share insights from my personal experience as a practice executor and from interviews I’ve conducted with individuals who lost their therapists to sudden death or incapacitation. I’ll also explore the importance of planning for the unexpected, the role of a professional will, and the responsibilities of a practice executor. Finally, we’ll examine the traditional methods of planning, contrast them with an expert-driven approach, and discuss their limitations.

Why Planning for the Unexpected Is Essential

Ethical Standards and Patient Welfare

Codes of ethics across mental health professions—including those from the American Psychological Association (APA), the National Association of Social Workers (NASW), and the American Counseling Association (ACA)—emphasize the importance of planning for the continuity of care. For example, APA’s Ethical Principles of Psychologists and Code of Conduct mandates that psychologists “make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted by factors such as the psychologist’s illness, death, unavailability, relocation, or retirement.”

Failing to create a professional will can lead to:

• Patient abandonment, which may retraumatize or destabilize vulnerable clients.
• Violations of confidentiality or state laws regarding record retention.
• Emotional and financial burdens for family members and colleagues.

Personal Reflections

As someone who has served as a practice executor, I know firsthand how overwhelming this role can be. One of the most difficult aspects was delivering the news to grieving clients. In one case, I had to notify over 30 patients of their therapist’s passing, provide referrals, and ensure continuity of care—all while managing the administrative tasks of closing the practice. The emotional toll was immense, and the process required far more time and energy than I had anticipated.

I also learned how emotionally challenging it can be when the executor is a friend or close colleague of the deceased therapist. The grief of losing someone you care about is compounded by the almost-unimaginable hours of work required to fulfill the executor role. From notifying clients to managing records and resolving financial matters, the sheer scope of responsibilities can be overwhelming. Through this experience, I realized how often the traditional methods place a disproportionate emotional and practical burden on close family members, who may be unprepared and ill-equipped to handle the complexities of closing a practice.

Through interviews with individuals who lost their therapists unexpectedly, I’ve learned how deeply patients can feel the effects of sudden termination. Some described feeling abandoned, while others expressed anger that their therapist had failed to plan for such an event. However, those whose therapists had left a comprehensive plan in place spoke with gratitude, noting that it helped them process their grief and transition to a new therapeutic relationship.

The Role of a Professional Will

A professional will outlines how a therapist’s practice should be managed in the event of their sudden incapacitation or death. Key components include:

• Patient Notifications: Instructions for informing clients about the situation.
• Continuity of Care: Plans for referrals and transition of care.
• Confidentiality: Guidelines for managing and securing patient records.
• Administrative Details: Steps for closing the practice, including billing, leases, and financial matters.

The Practice Executor’s Role

A practice executor carries out the directives in the professional will. This role typically requires:

• Clinical Expertise: Sensitively communicating with patients and addressing their immediate needs.
• Administrative Skills: Handling business closure tasks, such as record retention, billing, and notifying licensing boards.
• Ethical Judgment: Ensuring compliance with professional and legal standards.
  

The Traditional Methods of Planning

Under the traditional methods, therapists often either hire a lawyer to draft their professional will or rely on templates available online. They also typically name a colleague to act as their practice executor. While these approaches are common, they come with significant drawbacks.

Considerations

• Templates: Templates provide a low-cost, quick solution.  However, Templates are generic and often fail to address the unique aspects of a therapist’s practice. Critical topics, such as preferences for patient notifications, confidentiality nuances, and plans for vulnerable clients, are frequently omitted
• Consulting an Attorney: Lawyer’s fees for drafting a professional will can be very expensive, making this option less accessible for many therapists.  Also ,most lawyers are not equipped to address clinically sensitive topics, such as whether clients should receive different levels of information about the therapist’s medical situation or how much detail should be shared.
• Significant Burden on Colleagues: Colleagues often lack the time, training, and resources to fulfill the demanding role of practice executor. They may struggle to balance their own professional obligations with this additional responsibility.
• Unpredictable Costs at Execution: Executors typically bill by the hour, and the role often requires 80 or more hours of work. This can result in costs exceeding $20,000 for the therapist’s estate.
• Emotional and Practical Strain on Family Members: In many cases, the absence of a comprehensive plan leaves family members to handle the complexities of closing a practice. This additional burden can exacerbate their grief and create unnecessary stress during an already difficult time.
• No Ongoing Costs: Once the will is created, there are no annual retainer fees.
  

A Professionalized Approach

An alternative model involves hiring professionals who specialize in creating and executing professional wills. In this model, a clinician with expertise in practice closures and a lawyer collaborate to draft the will, while a professional practice executor—retained in advance—carries out the plan if needed.

Considerations

• Expertise in Planning: Clinicians experienced in practice closures ensure that the professional will addresses all critical aspects, from patient care to legal compliance.
• Guaranteed Execution: A professional executor specializes in fulfilling these responsibilities, with the time, resources, and training to manage them efficiently.
• Predictable Costs: Professional executor services often operate on a retainer model, with fixed annual fees that cover the cost of execution. This eliminates the financial unpredictability of hourly billing.
• Reduced Burden on Colleagues and Family: By outsourcing these responsibilities, therapists spare their loved ones and colleagues the emotional and logistical challenges of dismantling a practice.
• Enhanced Patient Care: Professional executors can provide timely and compassionate communication with patients, ensuring continuity of care and minimizing harm.‍
• Lower Upfront Costs: Engaging a professional executor and a clinician experienced in practice closures often costs less upfront than hiring a lawyer to draft a traditional professional will. Lawyers' fees can be prohibitively expensive, making the professionalized model more accessible for many therapists.‍
• Ongoing Annual Fees: Retainers for professional executor services require an annual commitment, which may feel burdensome for some practitioners.
  

Making the Ethical Choice

While the traditional methods may seem simpler or less expensive upfront, their limitations can result in significant downstream costs, both financial and emotional. By contrast, the professionalized model offers peace of mind, ensuring that therapists’ ethical obligations are met and their patients, families, and colleagues are well-supported in the event of an unexpected crisis.

For therapists, choosing the professionalized approach is an investment in the integrity of their practice and the well-being of those they care about. By confronting the discomfort of planning for the unexpected, therapists can honor their commitment to their patients and ensure that their legacy is one of compassion and responsibility.

Take Action Today

If you haven’t yet created a professional will, now is the time to start. Explore resources, consult with experts, and consider whether a professionalized approach aligns with your values and practice needs. Planning for the unexpected is not just a professional responsibility—it’s an act of care for your patients, colleagues, and loved ones.

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