Your End-of-Life Choices

Everyone should have someone who can make health decisions for them – a health power-of-attorney – especially if they are a boomer or older. They should also have a written expression of their wishes regarding life-sustaining treatment: in particular, how extensive life-saving interventions should be, given the likelihood of a painful closing process. It’s not enough, however, to make such ‘advance directives’ once, and then put them aside indefinitely. This is shown by a recent study of preferences for life-sustaining treatment at different times in the same person. It’s described in the Archives of Internal Medicine.

Over 800 physicians who graduated from Johns Hopkins Hospital between 1948 and 1964 were contacted, and completed questionnaires in 1999 and again in 2002. Their average age in 1999 was 69. During the 3-year interval between the questionnaires, the choices selected for life-sustaining treatment changed somewhat. They were asked about their wishes for these interventions: cardiopulmonary resuscitation, mechanical ventilation, IV fluids, a feeding tube, dialysis, chemotherapy, major surgery, invasive tests, blood or blood products therapy, and antibiotics, they were given choices classified as ‘most aggressive’ (most of the interventions), ‘intermediate’ (only IV fluids and antibiotics), and ‘least aggressive (most everything declined). Those physicians who did not have advance directives at baseline were more likely to select the ‘most aggressive’ options at 3 years.

Of those who had wanted the most aggressive treatment at baseline, 59% made a different choice at follow-up 3 years later. Half those who chose intermediate care originally chose another option (“most” or “least aggressive”) 3 years later. While 20% of the original “least aggressive” group at baseline wanted a change to another level. This shows that options change over time – within a relatively short period, at that. So make advance directives, but take them out and look at them every 3 to 5 years, as your views may have changed, especially if you’ve had the experience of watching a close friend or family member in their final illness.