A recent review article has shown that patients who have planned in advance for the end of their lives spend less time in the hospital, receive fewer intensive treatments, and have greater quality of life when they reach their final days. In addition, their surviving relatives experience less stress, anxiety and depression during the process.
These findings from studies that have been conducted over several years at multiple sites present a compelling argument for planning ahead for the end-of-life and completing advance directives. Yet recent statistics show that only 20-30 percent of Americans have actually put their healthcare wishes in writing in the form of a living will or other legal document, so as a nation we are vastly unprepared for the end-of-life.
To make matters worse, even when advance directives have been put in writing there are several reasons why patients may still not receive the care they have requested. Here are six common mistakes for you to avoid when doing your own end-of-life planning:
1. Putting it off for a later time
According to a survey conducted by The Conversation Project, some respondents say they have delayed completion of advance directives because it’s too early to think about it or they’re not sick yet. But evidence shows that making choices for end-of-life care is more difficult during a crisis situation. In addition, some preferences, such as avoiding CPR, may not be possible if they are not in writing before an emergency occurs.
The best time to do advance care planning is right now, as soon as the thought occurs to you. Then you will have your choices in writing no matter what happens, since life has its own set of uncertainties. The wishes you express now can always be updated whenever your health status or your preferences change.
2. Choosing the wrong healthcare proxy
Naming a person to make health care decisions for you in case you cannot speak for yourself is one of the most important steps in the process of advance care planning. But it is essential to choose the right person for this responsibility. Remember that some friends and family members may be too overwhelmed with their own grief or guilt to advocate for your wishes as you reach the end of your life.
You should choose as your proxy someone you trust who is emotionally strong enough to stand up to pressure from the medical system or loved ones in order to protect your wishes. This person also should either agree with your choices or be supportive of your right to choose in order to advocate for you. Finally you should consider whether or not the person is both willing and able to represent you now and in the future.
3. Getting lost in the details
When planning ahead for future health care decisions, it quickly becomes obvious that there are millions of potential scenarios that could play out at the end of your life. You could spend months considering every possible circumstance and making decisions for each situation, but that would be an unfortunate waste of your time.
Instead of getting lost in all the possible details for the future, ask yourself simple ‘big picture’ questions like “What do I want it to be like when I die?” By starting at the end, you can work backwards and other decisions will become more apparent. For example, if you wish to be in your own home when you die, then you will want to avoid types of treatment that would require hospitalization during your final days.
4. Not discussing your plans with your doctor
A large study found that even when patients had taken the time to complete advance directives only 25 percent of their physicians knew that the documents were on file. Your health care wishes are not likely to be carried out if your doctor doesn’t know what they are and cannot access your paperwork.
Schedule an appointment with your treating physician to talk about your end-of-life preferences and to ask for input. This will ensure that three factors of effective end-of-life planning are met: you will have the information you need about your health status in order to make decisions, your doctor will know what you want and will also know where your directives are stored.