Your Decisions on Medical Care at the End of Life

Talk openly with your loved ones while you’re still well and use advance directives to maintain control. It is important they know what you want when you die.

Just as you want control of your everyday decision-making during your life, you want it at the end of your life. 

Anne, a 59-year-old woman with advanced breast cancer, completed an advance directive when she was 50 to retain control over her end-of-life decisions, according to a report in the New England Journal of Medicine. 

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Anne wrote down what she wanted just after her parents died unexpectedly from lung cancer and a stroke, before she was diagnosed. Her advanced directive included the instruction that she would not be intubated if she was terminally ill.

Anne also wanted to discuss treatment options that would give her maximum time with her family and wished to pursue therapy “that (would) help her make it to next spring and beyond.”

“Anne's primary care physician needs to take the lead in initiating conversations about her goals,” the report said. “Anne has opened the door to conversation. A starting point at (a doctor’s) visit might be to review the advance directive that she completed nine years ago and to explore what is most important to her, helping match future care and treatment to her goals.”

That’s the advantage of an advance directive. 

“Americans are a people who plan…. The one area that most of us avoid planning is the end of our life,” adds a report from the Family Caregiver Alliance. “Yet, if we don't plan, if we don't at least think about it and share our ideas with those we love, others take over at the very time when we are most vulnerable.” 

If you’re ill and need to consider how you want your end-of-life treatment to go, completing an advance directive before you get to that point is a good place to start.

You need to confront your fears first, which could involve (among other matters):

• The possibility of pain
• Loss of dignity during treatment
• Not being clearly understood
• Being alone
• Being overly sedated
• Leaving unfinished projects behind
• Dying in a strange place 

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Once you know that you want to explore those topics and make plans, you should talk openly with family and friends about how you want the picture at the end of your life painted. 

You should also ask your doctor when you can talk about end-of-life treatment and medical decisions. 

Ask for guidance on preparing an advance directive. If you’re sick, ask your doctor what might happen when you start feeling worse. Let your doctor know how much information you wish to receive about your illness, prognosis, care options, and hospice programs as your illness worsens. 

It’s not always easy to talk about your end-of-care wishes, but it’s the simplest way to make them know, notes the National Institute on Aging (NIA). 

“As hard as it might be to talk about your end-of-life wishes, knowing your preferences ahead of time can make decision-making easier for your family,” the NIA says. “You may also have some comfort knowing that your family can choose what you want.”

A durable power of attorney for healthcare form and a living will are other forms of advance directives, as is a do not resuscitate order.

• Durable power of attorney for healthcare lets you designate a specific person or persons to make medical decisions on your behalf if you can’t.
• A living will conveys instructions to health professionals on matters such as resuscitation.
• A do not resuscitate order, or DNR, tells hospital staff not to perform life-saving measures, such as CPR.

After you complete your advance directives, you should review them periodically to make sure they still reflect your current wishes. You can easily complete new documents to update your instructions; the changes become legally binding.

Whatever your medical condition, you have the right to make your own decisions at the end of your life. You can document your wishes about where you want to be, who you want to be with and, what you want to happen.

But you will need to make financial and legal plans and instructions for your healthcare providers and loved ones known beforehand, so your wishes are accepted and carried out.

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