Advance Directives: Having the Talk
How to Talk to a Loved One About Making a Living Will and Durable Power of Attorney for Health Care
Imagine that your elderly father's emphysema has worsened dramatically. You're worried. If he becomes too ill to breathe on his own, what would he want for himself? How much should doctors intervene? If he's not able to make his own medical decisions, who would he want to speak on his behalf?
You're uncomfortable raising these questions, and when you finally do, he waves you away. "When the time comes, you'll know what to do," he says.
No doubt, it can be daunting to talk to loved ones about their medical preferences, especially near the end of life.
"It's quite difficult because virtually no one wants to think about dying," says Porter Storey, MD, executive vice president of the American Academy of Hospice and Palliative Medicine.
But it's important to talk about it -- to help you honor their wishes, and for your own peace of mind. And there are tactful ways to do it.
That discussion can help people put their wishes in writing in legal documents called advance directives. Doing that not only helps guide doctors; it could also prevent you and your family from becoming mired in confusion, guilt, and disagreement over tough medical decisions.
What Are Advance Directives?
Advance directives are legal documents that take effect when someone is no longer able to speak for himself or herself. They include:
- Living will: a legal document that guides health care professionals, family members, and trusted friends in understanding the types of life-sustaining measures that a person would want or not want
- Durable power of attorney for health care (DPA): allows a person to legally designate a family or friend to make medical decisions if he or she isn't able to do so
Without an advance directive, family members may disagree about how to proceed with medical treatment. That's a source of friction at a very trying time.
Benefits of Advance Directives
Storey, who practices palliative medicine in Colorado, has seen firsthand how tough it can be for families to talk about advance directives.
"Young people don't want their parents to think they're trying to get rid of them," he says. And many people don't want to think about death. "You see people who are old with several terminal illnesses who never think they're going to die."
But talking about an advance directive doesn't have to be so difficult, says David Casarett, MD, associate professor of medicine at the University of Pennsylvania and chief medical officer at Penn's hospice and palliative care program.
"If you think about advance directives as being all about death and dying and the final days, then it's really difficult," he says. "If you think about them the way they're intended -- which is if a family member ever gets to the point where they're not able to make decisions for themselves for any reason and they have a serious illness -- advance directives are really all about helping the family to come together and do the right thing."
"Framed in that light, in my experience, a lot of people are not only willing, but enthusiastic about doing advance directives," Casarett says. "It helps to make sure a family comes together and doesn't wind up arguing or disagreeing -- framing advance directives as doing something for their family, rather than for themselves."