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Why Advance Healthcare Decision-Making is Critical

Very often, EAIME Advocates work with clients who initially have questions and concerns about assigning a medical power of attorney (POA) or  creating an advance directive.  No one likes thinking about what happens when we’re very sick or dying, and many people worry that a proxy will “take over” decision-making in ways that don't align with their wishes, so these can often be challenging conversations.

Since we can’t predict the future, though, it’s critical to share our wishes in advance with someone who is legally able to represent our health care interests in the event that we can’t do so ourselves.

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One of our Advocates shared her experience of working with a client who became critically ill – and who didn’t have a medical POA or any documentation about his end-of-life care wishes.  “When my client entered the hospital after breaking his shoulder, everyone thought that he’d spend a little time in rehab and head home.  But instead, another chronic health issue worsened, and one of its consequences was that doctors found he no longer had the capacity to make his own decisions about the care he received.  Without an advance directive or a healthcare proxy, the medical team was legally required to put him on a ventilator, something he repeatedly said he did not want.  He spent the last month of his life living that way: sedated, restrained, and intubated. I went home from my last visit with my client and, with my partner, immediately began planning for our own advance directives.”

Research indicates that more than 70% of older adults prioritize quality of dying over longevity, yet unless they’ve formally expressed their wishes or given a proxy the ability to make decisions on their behalf, doctors may be required to provide aggressive treatment that they would not choose for themselves.  Individuals who complete these kinds of directives are less likely to die in the hospital, more likely to receive care consistent with their preferences, have proxies that report better communication with physicians near the end of life, and, in some cases, receive less costly care.  Yet research highlights how underutilized these safeguards are:  in an analysis of 150 articles on advance healthcare decision-making, researchers found that only one in three people have established formal, documented plans.

To help kickstart what can be a challenging discussion, The Conversation Project provides a number of guides to help you have conversations with the important people in your life about you – or their – wishes for care through the end of life.  If you’ve been asked to be a health care decision-maker, there’s also material that outlines the responsibilities of the role and how to honor your loved one’s wishes.  The guides include a number of tools that help you to reflect on your beliefs, values, and what’s important to you about the way you live – and die.

If you’re over the age of 18, you should identify and formalize a healthcare proxy – and review that choice regularly – to ensure that your wishes are honored when you aren’t able to share them yourself.

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