End-of-Life Care: Who Will Speak for You?

Put your end-of-life wishes in writing

End-of-Life Care: Who Will Speak for You?

No one wants to consider their own mortality. Eventually, though, it’s something we all must face, so it’s best to make some hard decisions now, to guide our loved ones and healthcare providers about what we want at the end of life.

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Today is National Healthcare Decisions Day, which hopes to encourage everyone to put their end-of-life wishes in writing. It’s also a day to remind healthcare providers – doctors, hospitals and care facilities – to respect those wishes, whatever they may be.

All too often, though, most people’s wishes go unexpressed. Various studies show that only about a quarter of all adults have prepared advance directives.

Don’t be intimidated, though. Advance directives can be created without a lawyer, for free, and relatively easily. They come in two main forms:

  •  Healthcare Power of Attorneys (HCPoA) identify the person (sometimes called a “proxy,” “agent” or “surrogate”) you choose to speak on your behalf if you cannot speak for yourself.
  •  Living will delineates which medical treatments you would or would not want at the end of life.

While preparing advance directives, it’s important to include your caregivers. Unfortunately, most don’t. The U.S. Agency for Healthcare Research and Quality found that just 12 percent of patients with an advance directive had received input from their physician.

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Even among patients who have an advanced directive, most doctors – 65 to 76 percent – say they were not aware that it existed. This can be remedied by including the directive in the patients’ electronic medical record, although less than 50 percent of the severely or terminally ill patients had a directive in their medical records.

That’s why Cleveland Clinic and many other healthcare providers nationwide are taking part in today’s National Healthcare Decisions Day.

To increase awareness and decrease the stigma associated with Healthcare Power of Attorneys (HCPoA), we are encouraging all of our caregivers to complete an HCPoA or bring in their already-completed HCPoA to be scanned into their electronic medical record.

We’d like patients to do the same. For those who already have an advance directive, take it with you to your medical appointments and make sure it is are part of your medical record.*  For those who still need to fill out directives, we offer the proper forms, links and Q&As on our website.

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This may not be something we want to talk about, but it’s certainly something we need to talk about.

*Cleveland Clinic patients can add their directives to their medical records by faxing the forms to Cleveland Clinic’s Advance Directive Coordinator at 216-444-9050 (To confirm receipt of fax, call 216-444-0655) or mail the forms to Cleveland Clinic Advance Directive Coordinator, Care Management, Desk P87, 9500 Euclid Ave., Cleveland, OH 44195-9905.


Delos M. Cosgrove, MD

Delos M. Cosgrove, MD, is President and CEO of Cleveland Clinic, where he presides over a $6.7 billion healthcare system.
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