Taking Care of the Dying with Living Wills

Addressing the Sensitive Topic of Death

People are living longer today than ever before, yet while they’re alive they’re inflicted with more disease. Modern medicine has enabled people to live longer lives even with terminal illness. However, the last years of life are not always enjoyable, and often involve surgery, chemotherapy, or other measures in the final years and even weeks. Many people die alone, and die in pain. Some receive treatment against their wishes, because hospitals will do whatever they can to keep a patient alive, unless they have explicit direction from family members not to. That’s where having a living will becomes important.

Since 1900, the global life expectancy has increased from 32-years-old to 71.8 years-old. That’s more in four generations than in the previous 8,000, and all due to medicine. In the United Kingdom, about three-fifths of deaths are estimated to come from a slow decline of function, including multiple recoveries from illness. In rich countries, it’s not uncommon to spend eight to ten years at the end of life with a serious illness. One-eighth of Americans with terminal cancer receive chemotherapy in their last weeks, and one-third of elderly Americans have surgery in their last year of life, even though most of the time doctors know these measures won’t make a difference.

These last years can be uncomfortable and long. One hundred years ago, most people died at home. Now, fewer than a third of people die in their homes, according to the World Health Organization.

One problem here is consent. A study found that when it comes to stopping treatment, there is conflict between families and doctors in about half of the cases. The Economist conducted a study where people in the United States, Brazil, Italy, and Japan were asked questions about dying and end-of-life care. Most people said they wanted to die at home, but they did not expect to do so. In every country except Brazil, people said they would prefer to die without pain or discomfort, rather than extend their lives.

It’s helpful to talk to loved ones about these wishes, but sometimes even when they know what you’re hoping for, they cannot enforce them. One study found that between 12% and 24% of those who had lost someone close to them said the patient’s wishes had not been granted, and between 25% and 38% said the person experienced needless pain at the end of life.

Things are getting better. Medicare announced in 2015 that it would cover end-of-life conversations between patients and doctors. Still, it’s a good idea to take matters into your own hands now if you have a strong feeling about the way you would like to die.

A living will, a document that spells out the treatment you desire if you’re in a state where you cannot consent yourself, puts you in as much control as possible. Doctors can be skeptical of these wills because people’s desires change over time. Make sure to update your living will regularly to ensure you receive the care you really want at the end of your life.

ALO can help you put together a living will and update it throughout your later years. This protects you, and gives you and your family peace of mind that your wishes will be followed through. Download our Living Will Questionnaire, which will help you think about what you eventually want in your living will.

Living Will Questionnaire

Who will you name as your power of attorney?

What would make your life no longer worth living?

How important is independence to you?

How important is it to you to be self-sufficient?

Do you want treatment to extend any situation?

Do you want treatment only if a cure is possible?

In what situations would you like to be resuscitated?

How long would you like to be placed under mechanical ventilation?

How long would you want tube feeding?

Do you want dialysis, and for how long?

Do you want infections to run their course near the end of life, or do you want antibiotics?

Will you be an organ and tissue donor?

Do you want your body donated for medical research?

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