Tackling a Taboo Topic: Dealing with Advance Directives and End-of-Life Issues
Discussing your wishes for advance directives may not be easy, but it’s a conversation that can ultimately ease stress and grief for your loved ones.
Thanks to medical advances, Americans are living longer than at any other time in history. For many, the same medical technology that increases lifespan also increases quality of life. But for some, longevity comes at the expense of dignity and comfort, and in contravention of what they may actually want. Advance directives, or living wills, allow people to avoid such issues.
Making preparations for what is often referred to as a “good death” well in advance of any emergency health crisis can help alleviate stress for your loved ones by reducing the burden of decision-making at a time of emotional upheaval. They also are more likely to find peace after your death if they know that they followed your wishes.
In the absence of a living will, and if faced with family members who are in disagreement over how to proceed, doctors’ default is to treat. This results in many older adults undergoing treatments and interventions that don’t prolong life as much as they push back the inevitability of death.
Advance Directives and Your Doctor’s Role
It isn’t just your family who should be involved in discussing your living will. Your doctor also has an important role to play in giving you accurate information about your prognosis. He or she also can explain realistic treatment options so that you can make an informed choice about accepting medications and procedures that might extend your life but also negatively impact your remaining quality of life.
Your doctor is also very likely to be involved in your care at the end of your life, and can inform other health care team members and your family of your wishes. However, in order for this to happen, you need to discuss your end-of-life wishes with your doctor—and a 2009 survey carried out by the Agency for Healthcare Research and Quality suggested that as many as three-quarters of doctors whose patients had advance directives were unaware that those documents existed. The same survey data showed that only 12 percent of patients with living wills had received input from their doctor.
All of us would like to die peacefully and with dignity. We often can’t achieve that alone—but talking about death tends to be taboo. Many of us simply don’t want to acknowledge our own mortality, or can’t find the words to use when it comes to talking specifically about our own death.
There is little doubt that dying is a difficult subject—but it is a vital conversation, and it is much better to have that conversation when you can decide for yourself what treatments and interventions you want, and whether you would prefer to die at home. I know from my care of patients that an open discussion with your doctor can alleviate anxiety, while assuring you that your wishes will guide your medical care right up until the end of life. Be proactive about initiating such a discussion with your doctors in good times, so your wishes and dignity can be honored.
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Rosanne Leipzig, MD, PhD, is Professor and Vice Chair of the Brookdale Department of Geriatrics and Adult Development at the Icahn School of Medicine at Mt. Sinai in New York, N.Y. She also serves as Editor-in-Chief of the monthly publication Mount Sinai School of Medicine Focus on Healthy Aging. Visit her website at rosannemd.com.
Originally published in 2017, this post is regularly updated.
Rosanne Leipzig, MD, PhD, is Professor and Vice Chair of the Brookdale Department of Geriatrics and Adult Development at the Icahn School of Medicine at Mt. Sinai in New York, N.Y. She also serves as Editor-in-Chief of the monthly publication Mount Sinai School of Medicine Focus on Healthy Aging.