Some of us may not want life-extending procedures if our quality of life is poor. Whatever the decision, experts say to put it in writing so that family members and medical personnel know how to respond in an emergency or end-of-life situation if we are unable to communicate.
Among the ways to make your preferences known:
Prepare a living will (also called an advance directive) to document your medical treatment preferences in certain situations. It typically includes whether you'd want a ventilator, feeding tube, resuscitation — interventions that could prolong your life — if you were not expected to return to a functional state.
Create a health care power of attorney (or health care proxy, as it's also known), so the advocate you appointed can make sure your treatment preferences are carried out. It's a supplemental document to a living will, to some extent, because it gives your medical provider a designated advocate to consult if your wishes are hard to interpret in your living will, for example.
Copies of each of these documents should be given to your health care providers. Otherwise, medical personnel don't always know about your wishes, or worse, ignore them, Cottingham says.
"People want to experience a peaceful death, generally at home surrounded by loved ones," she says. "Instead, we see more people dying in the [intensive care unit], the exact opposite of what they want. We need to do a better job in getting people to document their wishes ... and to make sure medical providers are adhering to those documents."
A FindLaw.com survey released in February found that only 1 in 3 adults had a living will. In 2007, a Harris Interactive study said 2 in 5 adults had advance directives. It was no better among severely or terminally ill patients: The majority had no advance directives in their medical records, researchers for the federal Agency for Healthcare Research and Quality reported a few years ago.
With Thanksgiving approaching, experts say it's an ideal time to gather around the dinner table with friends and family to discuss these issues.
"Making a living will at the bedside of someone who's in a crisis situation is probably the least appropriate but most frequent time when people start talking about end-of-life care," says Sally Hurme, a project adviser at AARP and author of The ABA Checklist for Family Heirs: A Guide to Family History, Financial Plans and Final Wishes. "The conversation has to happen long before there's a health care crisis."
The talk should also extend to financial matters, says Susan Fulton, president at FBB Capital Partners in Bethesda, Md.
"If you died in your 50s, can your spouse afford to keep the house with the mortgage you have? If you can't, do you take out insurance or plan on downsizing now? What about the kids' or grandkids' education? If there's only one income stream, one set of assets, these are things you really need to think seriously about," she says.
Fulton also recommends designating a place to store your will, bank account information, investment statements and other documents so that your spouse or heirs have easy access when the time comes.
"You want the process to go as smoothly as possible," she says.
The same holds true for a living will. Fisher, as the head of a hospice, says she witnesses all too often the fallout when family members don't have their end-of-life decisions spelled out.
"I see families at odds with each other because they haven't had these conversations," Fisher says, "and Mom's not able to communicate. They're arguing about treatment versus hospice when they should be focusing on their grief."
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