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Are Americans Afraid to Talk About Dying?

Talking to Family, Friends Helps Make End-of-Life Decisions

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We don't have to understand every kind of medical procedure. We do have to come to terms with what is most important for us.

"We do not ask patients whether they want this or that treatment," Goldstein says. "We ask, 'What is important to you in terms of your health care? What are your goals in life?' So when we do that, we can say, 'Well, in terms of what you said, these are the treatments that are appropriate. These treatments are what meet your goals.'"

There are two different legal documents that improve our odds of getting the end-of-life care we want. One is a living will.living will. A living will spells out what kinds of extraordinary medical treatments we'd like used to keep us alive, in the event we become terminally ill or permanently unconscious.

While living wills are legal documents, you don't need a lawyer to get one. They are available free on the Internet. After explaining your wishes, you just need two witnesses to sign it.

"A living will gives patients an opportunity to express in their own words what is important to them," Goldstein says. "The difficulty is they often start with phrases that can be interpreted differently by different people. Like, 'If I am permanently unconscious or brain dead.' That is a clear statement in a narrow context. It tells us what a person would want but only in very defined conditions that may not come to pass."

A living will does not mean that doctors won't try everything medically possible to save your life. It means that you get the opportunity to explain under which circumstances you do not wish to have your life prolonged. In many people's minds, this is a point at which they can no longer take care of themselves or make decisions for themselves. For many, it's about quality of life.

In these situations, it's hard for doctors to try to interpret complex legal documents. That's why many doctors would prefer that patients designate a health care proxy. A health care proxy -- in some states called a durable power of attorney for health care -- is the person you choose to speak for you when you're not able to speak for yourself. Different states have different laws, but all provide a way for you to do this.

"Naming a health care proxy gives me, as a doctor, a person I can actually talk to," Goldstein says. "It's someone who can say, given the situation, what would this patient want. A health care proxy can sometimes be more helpful than a living will because it gives us a living, breathing person who can answer whatever questions may come up."

How can we ask someone we love to do this? Start slow, Lynn advises. And keep talking.

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