Dr. Clif CleavelandFaced with progressive, incurable and often painful disease, most Americans wish to die at home, free of pain, and in the company of loved ones.
In 1990, the U.S. Supreme Court recognized a patient’s right to decline therapy that would extend or sustain life. Congress. The Patient Self-Determination Act from the same year required hospitals, nursing homes, hospice providers and home health agencies to inform patients of their rights to decline treatment. An advance directive (AD) was recognized as the means for documenting personal desires for end-of-life care. Years were required to remove a variety of social, professional and legal barriers to widespread acceptance of ADs.
Also known as a living will, an AD lays out the patient’s wishes for care near life’s end. He designates a surrogate or stand-in decision maker in the event that illness or injury impairs his ability to make judgments. Times to consider an AD might include marriage, the attainment of a certain age milestone — say 50 or 65– or learning of a complex or potentially lethal disease.
Ideally before an AD is finalized, there will be a series of conversations with close family members, religious counselors, intimate friends and a personal physician. An attorney also may be brought into the discussion.
An AD begins with the naming of an agent and alternate agent. The agent may be a spouse, parent, child, sibling, or close friend. Next, the person selects the conditions in which he would be willing to live such as permanent unconsciousness or end-stage illness. Treatment choices are selected or rejected, including cardiopulmonary resuscitation, life support, treatment of complications or other disorders and intravenous or tube feeding. Other instructions relate to hospice care, organ donation and burial arrangements. A personal statement to loved ones may be included.