Nearly 37 percent of Americans have advanced directives for end-of-life care if they become seriously ill or unable to make health care decisions, according to a study. Roughly half of people with living wills or other types of advanced medical directives were not suffering from a chronic illness.
“Improving end-of-life care has been a national conversation for some time now, presumably because it will affect all of us at some point and is a very personal matter,” said Dr. Katherine Courtright of the Fostering Improvement in End-of-Life Decision Science Program at the University of Pennsylvania in Philadelphia.
The conversation has revived since Medicare, the federal health insurance program for people over age 65, began reimbursing physicians for advance-care planning counseling on January 1, 2016. The research team found that 36.7 percent of adults completed an advanced directive of some kind: 29 percent had living wills, 33 percent had health care powers of attorney and 32 percent had undefined advanced directives.
Older patients and those in hospice or palliative care were more likely to have an advanced directive, and end-of-life care documents were more common among those with neurologic disease such as dementia and least common among those with HIV/AIDS, according to the results published in Health Affairs.
“Everybody should have this conversation because our values and preferences change over time,” said Dr. Melissa Wachterman of Harvard Medical School in Boston. “A healthy 72-year-old may say she wants a breathing tube, but that choice may change.”
“At the end of the day, I’ve heard from too many families that they couldn’t agree on what to do for mom or dad, and it’s often not on your radar until it’s too late,” said Paul Malley, president of Ageing with Dignity in Tallahassee, Florida.
(Excerpted from an article in Reuters)
What are Advanced Medical Directives?
Living wills and other advance directives are written, legal instructions regarding your preferences for medical care if you are unable to make decisions for yourself. Advance directives guide choices for doctors and caregivers if you're terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.
By planning ahead, you can get the medical care you want, avoid unnecessary suffering and relieve caregivers of decision-making burdens during moments of crisis or grief. You also help reduce confusion or disagreement about the choices you would want people to make on your behalf.
Advance directives aren't just for older adults. Unexpected end-of-life situations can happen at any age, so it's important for all adults to prepare these documents.
Status of Advanced Directives in India
ADs have no sanction in India. Indian law does not recognise the AD as a legally enforceable document.
DNR is another related concept, which applies in only certain cases. A DNR order in a patient’s file means that resuscitation is not required if the heart stops. It is designed to prevent unnecessary suffering.