Advance Directives Not Enough

We keep running into people in their seventies and eighties who haven’t completed advance directives on end of life care. Evidently, they’re the exceptions, since a survey indicates that most seniors have done so. I hope that’s true. According to the Institute of Medicine’s Dying in Americaanother survey has found that for seniors 75 and older who say they have done advance directives, the documents cannot be found in their medical records in 53 percent of the cases.

If you haven’t filled out forms expressing your wishes for the end of life, you should certainly Hollyhocksdo so. It can save you from heroic but harrowing treatments — feeding tubes, tracheotomies, ventilators, and resuscitation after your heart has stopped — when you might have wished for a simple, peaceful death. Of course, if you want to have such heroic treatments and prolong your life until the last possible moment, you can express that wish too.

Your attorney can help you complete an advance directive, or you can find all sorts of resources to help you online. The AARPElder Law and NIH sites are extremely helpful, and the Five Wishes project offers forms that meet advance directive legal requirements in 42 states. Many states, such as Maryland and New York, offer free forms online.

Your wishes for medical treatment at the end of life will be specified in a “living will.” But your advance directive should also include a health care proxy form appointing someone you trust to make health care decisions for you when you are no longer able to do so. Ambiguous situations not explicitly covered by a living will can easily arise, and that’s partly why a proxy can be so important. Be sure to protect this relative, friend, or other trusted person by giving them a copy of your living will. This will help keep them from being wracked by guilt after you’re gone, wondering if they made the decisions you would have wanted.

An ongoing conversation with your proxy or with a broader circle of loved ones about the end of life is even more important than a living will. As the New York Times recently reported, in “The Trouble With Advance Directives,” “In a crisis, doctors will turn to those people — more than to any document — to learn what the patient wants.”

If you or your friends and family find a conversation about death difficult, Ellen Goodman‘s Conversation Project offers guidance on how to get it started.  The Death Over Dinner site can also help you prepare, and even suggests wording for an invitation.

Your advance directive doesn’t belong in your safe deposit box. Your proxy and other loved ones should have copies. So should your primary care physician and your attorney. You could keep a copy in the glove compartment of your car and certainly in a readily accessible place at home. Five Wishes and the state of Maryland offer templates for cards you can carry in your wallet telling where your advance directive can be found. Our peripatetic friends, the P’ville Seniors, tell us that they take their directives with them whenever they travel. Good advice, especially since today’s seniors are not known for sitting at home waiting for the inevitable.

In a future article, we’ll take a look at another document, Physician Orders for Life Sustaining Treatment (POLST), that can be even more effective — at least for the seriously ill and those in nursing homes — than an advance directive in preventing unwanted care at the end of life. A POLST even applies to emergency medical personnel, who otherwise, according to the Times, “operate under standing orders to attempt resuscitation, whatever an advance directive says.”


1 thought on “Advance Directives Not Enough

  1. Pingback: Dying: The Consumer Experience | Common Sense for Seniors

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