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Children Stick With Decisions Made About Dying Parents

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The study results are no surprise to Norman Ables, Ph.D., professor of psychology at Michigan State University and past president of the American Psychological Association. "These are such excruciating decisions made under such stressful situations, it seems most people wouldn't want to change their minds about it," he says -- mainly because people want to believe they did the right, best thing for their loved one.

"The difficulty, of course, is you can't always tell when the end of life is going to occur," he adds, as some terminally ill patients can linger for weeks or even months.

Given the complexities involved in these decisions, one physician recommends families discuss their own mortality. "You don't have to anticipate getting Alzheimer's tomorrow, but you do have to anticipate the possibility of getting into a car accident tomorrow," says Lissy Jarvik, MD, PhD, professor emeritus at the University of California, Los Angeles.

She says those discussions should take place relatively early -- perhaps when the children have reached their twenties -- and that if a living will has been executed everyone should know where it is. "At the last minute and under pressure, often the living will can't be found," she says, "and the children don't know one exists."

And in most cases in the U.S., one won't exist. According to John Banja, PhD, an associate professor in the department of rehabilitation medicine at Emory University in Atlanta, only about 25% of patients have one -- and in some situations they offer no protection. For example, "[there is no protection] when a family member can't tolerate the idea -- even with a valid living will -- that a health care provider is going to discontinue life-prolonging treatment," Banja says. Threats to sue often follow, and he says "invariably" the health care provider backs down.

An even more powerful legal instrument is the Durable Power of Attorney for Health Care. It gives another person power over medical decisions, and its scope goes beyond that of the living will. Banja says while the living will only covers three prognoses: terminal illness, persistent vegetative state, and irreversible coma, the power of attorney covers other situations in which a patient may be extremely sick.

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