A living will is not enough
Talking about what exactly will happen to us as we die is not something that many of us may be comfortable with. Often we turn to putting our wishes in writing through a living will.
But a living will can only provide a doctor with fairly general principles about treatments that serve only to prolong the dying process. How these principles will be applied remains in the hands of the medical team. Our lack of comfort in discussing how we would like to die can lower the standard of care we receive.
Things change for many of those faced with imminent death, however, as a recent study in the U.S. shows. Very elderly and chronically ill patients are actually eager to discuss “end-of life directives” such as the use of life support systems. Unfortunately this same study shows that they are also afraid of raising the subject with their doctors.
Doctors should initiate discussions
According to the study reported in the January issue of the Journal of General Internal Medicine, doctors should initiate discussions about “end-of-life-directives” because that is what most of their patients really want.
“In geral, doctors think patients should initiate such a conversation and patients think its something their doctor should bring up–consequently these important talks are not happening,” said William M. Tierney of Indiana University School of Medicine in Indianapolis. “Doctors seem to have this belief that their patients won’t like such conversations. They feel that they might worry patients needlessly, especially older patients coming in for check ups.”
The study surveyed 686 patients who were at least 75 years old, or over 50 and suffering from serious underlying diseases, along with their primary care physicians. An astounding 98 per cent of the patients had never spoken to their doctors about crucial matters such as what sort of life-saving interventions they wanted.
Clear communication is the key
Some of the patients did have such discussions prompted by their doctors during the study. More than half of these patients rated subsequent office visits as “excellent”, while only 34 per cent of those who hadn’t had these talks rated their doctors as “excellent”. The study’s authors say that the figures suggest that elderly, chronically ill patients are more satisfied with their doctor and the care he or she delivers when they have had these discussions.
As always, clear communication is the key, and doctors are encouraged to initiate discussion with their patients. The study’s authors also advise patients to ask their doctors for specific forms to cover a broader range of topics than the standard “living will”, since these documents can be too vague to be effective when the patient is dying.
If we want our values to be applied when actual health care decisions are being made, it is important that we open the lines of communication – even when it’s uncomfortable. And as this study shows, it’s even likely to make us feel better.