Why the Best Time to Plan for End-of-Life Care is Now

Bad events will occur, even if we don't expect them
A senior citizen signing a document.

Contributor: Ronan Factora, MD

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As you get older, it’s important to plan ahead to make sure your financial and medical wishes are addressed and overall well-being is ensured.

While you should pay attention to a number of medical and legal documents as you get older, most people don’t think about end-of-life care until they reach a point where the issue can no longer be ignored. Many times, this takes place very late in life — often in a hospital setting during a health crisis.

At the same time, we would not leave issues such as health or life insurance to chance, and discussions regarding car insurance are commonplace. These assurances are because one cannot predict everything that will happen in life. We want to be prepared for the possibility that bad events will occur, although we do not necessarily expect them to occur.

Similarly, events that may affect health cannot all be anticipated. Why is it, then, that we are uncomfortable addressing and discussing our wishes for end-of-life health care? Preparing advance directives and a living will are important decisions to make, just like any discussion of insurance-related issues. In fact, delaying these discussions until a health crisis occurs can put significant stress and strain on family members.

Advance directives are documents that direct how your health care can be delivered in the event that you are no longer able to make the decisions for yourself. This includes identifying a surrogate decision maker, often called a durable health care power of attorney (DHCPOA) as the individual who will make the medical decisions for you if you are unable to make them yourself.

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This person could be a spouse, family member, close friend or a respected member of the community. The key factor in assigning this responsibility is that you trust this individual to make medical decisions that would be consistent with your wishes if you were unable to make them yourself. Activation of a DHCPOA is meant to be temporary, and anticipates that you would eventually recover enough to make medical decisions again.

DHCPOA is different from a living will, which directs how end-of-life care should be provided to you. This may include whether you would want to have cardiopulmonary resuscitation or for mechanical ventilation (placing a patient on a breathing machine when the patient is unable to breathe for themselves) to be performed to sustain or save your life.

Again, deciding these things does not necessarily mean you are expecting them to occur, but it allows you express how you would like to have them handled if they ever arise in the future.

It’s important for all family and friends be made aware of the content of these documents. This will help ensure your wishes are followed. The documents also should be provided to your medical providers so they can access the documents when necessary.

A final thought is these decisions can be changed if needed — just because an advanced directive is notarized does not mean it is permanent.

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Deciding end-of-life care involves making important decisions. It is best not to leave this decision-making for later in life or when you are ill, because you may struggle with memory and cognition. The most important thing I suggest patients do is at least start the discussion. That’s certainly a step in the right direction toward ensuring appropriate end-of-life care.

This post is based on one of a series of articles produced by U.S. News & World Report in association with the medical experts at Cleveland Clinic.


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