Surveys show that most people have not named an agent to make health care decisions if they are unable to speak for themselves, nor have they directed in advance their wishes for their healthcare. The usual reasons given are that people do not want to confront their mortality and, for those being treated for a serious condition, feel that addressing it means they have given up fighting to live.
A recent study, however, indicates other reasons – people do not see the need because they mistakenly believe they will die quickly or they are uncertain about the course of their final illness. Dr. Katriina Hopper, who was intrigued by many patients and relatives of patients saying, “I didn’t think it would be like this” as the patient’s condition worsened and the end drew near, designed a study to find out what people expected.
Patient Expectations Study Sheds Light on Lack of Urgency for End-of-Life Planning
Dr. Hopper posed the following question to 185 patients who had advanced cancer, heart failure or lung disease and qualified for hospice (meaning they likely had six months or less to live):
Which of the following best describes what you think the course of your final illness will be?
A.will die suddenly
B. will die within a day or two of a serious complication
C. will die after prolonged illness
D. I don’t know.
Dr. Hopper’s survey also asked whether the patients were depressed, in pain, or had taken care of a sick person for a long time. These factors did not influence participants’ expectations – patients who were depressed or in pain were just as likely to answer “I don’t know” as those who weren’t. Surprisingly, even those who had taken care of a sick person for a long time were no more likely to think they would die after a prolonged illness as those who hadn’t been a caregiver.
About 25 percent thought they would die suddenly, or within a day or two of a serious complication, and about 40 percent responded “I don’t know”. All in all, about two-thirds thought they would die quickly or were uncertain.
This sheds some light on why so few people do their planning – they do not feel the need. If you think you will die suddenly or relatively quickly, or you are uncertain, you are not compelled to document your healthcare wishes and name the person you would want making decisions for you. It does not seem urgent.
Reality Check and Reframing: Your Final Care for Your Loved Ones
The reality check is that very few people die suddenly or in their sleep. It is more likely that one will die after a prolonged illness. So, there is a real need for this planning in most people’s lives.
By naming your healthcare agent (and alternates) and by specifying any treatments you do or do not want, you not only preserve your wishes, you also prevent your loved ones from arguing over who you would have wanted to make decisions and what decisions you would have wanted.
By developing a “care philosophy”, you help your agent and loved ones make decisions and make peace with those decisions. Is it helpful for your loved ones to see every last effort made? Or, would it be better for them if you were in a hospice setting or had a Do Not Resuscitate Order? Do you want your agent to be mostly concerned with your comfort and minimizing pain? Do you have a certain event that you are looking forward to and want to live until it happens? You could document your “care philosophy” in a letter or simply discuss it with your loved ones.
If you’d like to learn more about Healthcare Agent designations, Advanced Directives and other aspects of estate planning in Orange County, call our office today to schedule a time for us to sit down and talk. We normally charge $750 for a Family Wealth Planning Session, but because this planning is so important, I’ve made space for the next two people who mention this article to have a complete planning session at no charge. Call today and mention this article.
