By Eunjeong Ko
U-T San Diego
May 22, 2012
As the aging population grows, increasing attention will be given to health care needs and issues around end-of-life care. Modern technology contributes greatly to extending life, yet raises much debate about quality of life.
The quality-of-life issues are particularly important to consider when there is little or no possibility of recovery. Although death befalls everyone, its coming eventuality is often the most salient for older adults. Older adults may have thought long and hard about what treatment steps they would like to see taken or not taken in the event of a terminal illness. As a way to make the terminally ill patients’ preferences regarding treatment known, an advance directive is an important tool.
An advance directive is a legally binding document through which individuals express their life-sustaining treatment preferences and designate power of attorney to someone who will ensure those preferences are followed if the need arises. When preparing an advance directive individuals should review treatment options and share their decisions with their physicians and family members so that their wishes are honored. This promotes a quality end of life. The advance directive conveys whether all possible efforts should be taken or not taken to maintain life as long as possible.
In spite of the ongoing efforts to promote advance directive in public health, the research shows that only about 36 percent of the U.S. public has utilized it. Not knowing a patient’s wishes about end-of- life care treatments has several consequences. Decision making for what medical steps should be taken to extend life often falls to a family. This may often become a challenge for them to reach consensus as each family member expresses divergent values and care preferences. Conflicts between family and physicians may also cause distress. Most of all, those patients who would not opt for extreme methods to extend life may suffer from receiving unwanted treatments. Finally, unwanted health care costs are incurred which are a burden to the family and society.
Why do older adults not use advance directives? The most commonly cited reasons are lack of knowledge and misconceptions. Many people do not know the following facts about the advance directive.
• An advance directive does not manage monetary affairs. It addresses your health care choice, in particular, end-of-life care treatment preferences.
• Advance directive can be revoked or modified at any time.
• Any individuals age 18 years or older can complete an advance directive. Making decisions while one is severely ill can be more difficult as physical symptoms can increase emotional distress and impair judgment.
• Clear communication about one’s preferences via both informal dialogue and formal written documentation can prevent potential confusion among family members. This is especially true for certain groups such as Asians and Hispanics whose cultures focus on collectivism, which can cause more problems as each family’s input and voices are considered to be important in making decisions.
End-of-life care is a complicated process that often involves others in the decision-making process. What constitutes a good death varies by culture, but peaceful and pain-free death has been the universal theme in the concept of dying well. This may be the time for us to think about what we want during our final stage of life and how we want to prepare to make it more meaningful.