Children Stick With Decisions Made About Dying Parents
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.
But before settling on an "end-of-life" plan, Banja says families
should know some medical facts -- such as the relative futility of trying to
resuscitate an elderly person. He says while television shows such as
"ER" show "phenomenal" resuscitation rates -- with around 70%
of patients recovering -- the success rate in sick, elderly patients can be
more like 5%.
And Banja adds that in some cases resuscitation does more harm than good.
"I have been at some hospitals where the nursing staff will take one look
at a patient in the ICU and say, 'No way do I want to do cardiopulmonary
resuscitation on this patient.' It's because the patient is in such bad
- In a group of adult children whose parents were dying 6 years ago, most did
not regret the medical choices they had made for their parents, even though
about half did not know what their parents' wishes were.
- Families should discuss their mortality relatively early, and everyone
should know whether a living will exists and where it is located.
- In a second group of people, who had not gone through the death of a close
relative, twice as many said they would request a DNR order or euthanasia.