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End of Life Decision-making: The Ultimate in Patient Empowerment

Preparing for Your Final Wishes


Updated September 06, 2013

For many, death is simply considered the final phase of life. And depending on what will get you there, you may have the ability to control how that phase happens for you.

Controlling the End of Life

Not everyone can control how his life will end. Certainly accidents happen, or strokes or heart attacks cause sudden death. In those cases, the end may happen in an instant.

But the majority of us will know in advance that the end of life is near. Old age, bad hearts, disease -- these affect us over a period of time, and we know that eventually we will die.

The ultimate aspect of patient empowerment is to determine how your end of life will take place. Answering questions ahead of time, based on your wishes, not only gives you the peace of mind that goes with knowing how it will happen, but provides your loved ones with guidance on how to make decisions on your behalf.

What is an Advance Directive?

As you approach those final weeks or days or hours of your life, what are your wishes about aspects such as keeping you alive on machines or jump-starting your heart so it won't stop? Do you wish to have a respirator breath for you? Or do you want to be fed through a tube threaded down your throat to your stomach?

These are the kinds of answers you provide through development of an advance directive. It's a legal statement of your wishes for end of life care. Sometimes patients ask whether they have the right to refuse treatment. Advance directives are the documents that support those treatment refusal decisions.

You may recognize some of the other terminology used for advance directives. Living wills, DNRs (do-not-resuscitate), healthcare proxies and others are considered advance directives.

Legal Requirements Are Affected by Location

Each state in the US and each Canadian province has different guidelines for which documents are legally recognized and binding. For example, New York State does not recognize living wills as legal documents, although in some circumstances they will be recognized as indications of a patient's wishes. And some states and provinces require advance directives be notarized, while others don't.

Two Aspects of Making Your Wishes Known

Making the transition from living to dying requires more than just development of a legal document. One of the major benefits to creating your advance directives will be the discussion you have with your loved ones about your wishes.

If you should suffer a prolonged illness, or if you lose consciousness or can't speak, you may have trouble discussing your choices with those who will need to make decisions on your behalf. As you develop your directives, it is imperative you discuss them with your designated decision-maker, your proxy, so he will know what your wishes are.

Noting your wishes in legal documents won't do you much good if those who must make decisions for you don't know they exist. Be sure to discuss them with your family, help them understand why you make the choices you make, and make sure you clear up any misunderstandings before your documents must be invoked and decisions must be carried out.

An empowered patient will think through her end-of-life wishes, will make them known to her family, and will develop the documents necessary to make them happen.

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