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Questions & Answers: Advance Directives and End of Life Decisions

Why do I need advance directives?

Advance directives give you a voice in decisions about your medical treatment, even if you are unconscious or too ill to communicate.

As long as you are able to make and express your own decisions, you can accept or refuse any medical treatment. But if you become seriously ill, you might lose the ability to participate in decisions about your own treatment.

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Widows / Widowers

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Research has shown that 80 percent of us now die in a medical facility such as a hospital or nursing home, as medical technology can now prolong life as never before. The quality of that life, however, may be greatly reduced. As a result, many patients, families and caregivers face difficult questions about how much technology to use when the patient cannot get better. That means most of us will face a decision about whether to use life-sustaining treatments at the end of our lives. If we cannot speak for ourselves at that point, other people will have to make the decisions for us.

Providing your loved ones and caregivers with the information they need to make medical decisions for you is a great gift. It can spare them emotional anguish and conflict. Making end-of-life decisions for someone else is difficult and painful for loved ones and caregivers. You can make those decisions much easier for your family by talking about your wishes while you are able to do so. If your loved ones do not know your preferences, decisions are even harder to make and serious conflicts can arise between your family and medical caregivers or within your family itself. Without clear evidence about a patient's wishes, some care providers will continue treatment, not only because they are trained to do so, but also to protect themselves from any liability. Even if your loved ones believe that you would not want a treatment, they might not be able to stop it without some direction from you depending on the state.

Remember, it's up to you to take the initiative and express your wishes. Your family or doctor is not likely to raise the issue for you.

Why bother with advance directives if I want my family to make the necessary decisions for me?

Depending on your state's laws, your family might not be allowed to make decisions about life-sustaining treatment for you without written evidence of your wishes. Although doctors usually turn to the next of kin to make most decisions when patients cannot speak for themselves, a decision to withhold or stop life-sustaining treatment often is handled differently because of its final nature.

Some state laws do permit family members to make all medical decisions for their incapacitated loved ones. However, other states require clear evidence of the patient's own wishes or a legally designated decision maker. Written evidence, such as a living will or medical power of attorney, generally is honored more readily in these situations than previously made oral statements.

WebMD Medical Reference from the National Hospice and Palliative Care Organization

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