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
When heart specialist John M. Kennedy, M.D., of Harbor-UCLA Medical Center, stands at the scrub sink before an operation, he breathes deeply with seven-count exhales, visualizing how he wants the procedure to go. "Athletes use these techniques to perform under pressure, but we can all call on them in our regular lives," Dr. Kennedy says. It starts with knowing what kind of breathing works best for the challenge you're facing. Here's what the latest research shows.
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
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
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