Suzanne B. O’Brien here,

The Holiday season is here. The time of year where families come together, we put our work life on pause for a while and appreciate what is most important to us. It is the season where loved ones gather to share meals, stories, and connect with one another. It is a time defined by togetherness. Families who spend quality time together and connect through activities have a stronger bond and better communication. The holiday season provides great opportunities to expose one another to new ideas and information, and to encourage conversation. Schedules can be grueling during the holidays, but we must remember that the most important part of this season is spending time with the people we love. This is also a perfect time to have a discussion with your loved ones about their end of life wishes and how they can legally protect those wishes with advance directives.

An advance directive, also known as a living will, personal directive, advance healthcare directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. A living will is one form of advance directive which leaves instructions for treatment. Another form is a specific type of power of attorney or health care proxy, in which the person authorizes someone (an agent) to make decisions on their behalf when they are incapacitated. We encourage people to complete both documents to provide comprehensive guidance regarding their care.

Advance directives were created in response to the increasing sophistication and prevalence of medical technology. Of U.S. deaths, 25% – 55% occur in health care facilities. Numerous studies have documented critical deficits in the medical care of the dying; it has been found to be unnecessarily prolonged, painful, expensive, and emotionally burdensome to both patients and their families. Aggressive medical intervention leaves nearly 2 million Americans confined to nursing homes, and over 1.4 million Americans remain so medically frail that they can survive only through use of feeding tubes. As many as 30,000 people are kept alive in comatose and permanently vegetative states. Cost burdens to individuals and families are considerable. A national study found that: “In 20% of cases, a family member had to quit work; 31% lost all or most savings (even though 96% had insurance); and 20% reported loss of their major source of income. Yet, studies indicate that 70-95% of people would rather refuse aggressive medical treatment than have their lives medically prolonged in incompetent or other poor prognosis states.”
As more and more Americans experienced the burdens of and diminishing benefits of invasive and aggressive medical treatment in poor prognosis states – either directly themselves or through a loved one – pressure began to mount to devise ways to avoid the suffering and costs associated with treatments one did not want in personally untenable situations. This is what led to the availability of advance directives. It has also been proven that the bereavement process for families can be much less emotionally painful when their loved one had filled out an advance directive before entering their final stage of life or a state that results in an otherwise inadequate quality of life by assuring the family that their wishes have been respected and that they were cared for on their own terms. Knowing that the holidays are a joyous occasion and that these types of conversations may be hard to bring up, we have compiled some conversation lead-ins that can help you break the ice and facilitate a normal discussion revolving around the importance and necessity of filling out an advance directive.

1. Make yourself the focal point. “Mom and Dad, I want you to know that I have made some very important decisions about what I would want or not want for end of life care. I would like to share them with you and allow you to ask me any questions.”

 2. Bring up the subject in an indirect or arbitrary way. “I have been reading some very interesting statistics about aging. 9/10 people say they want to stay at home during the end of life. How do you feel about this? How can we make this possible?” Through Advance Directives, of course!

 3. Bring up a situation that “a friend” is experiencing and then bridge into a conversation about you and your loved ones. “My friend has just gone through an awfully difficult time with her mother in the hospital and the daughter knew her mother would not want to be kept in a vegetative state. Because her mom had no Advance Directive forms, the family was fighting and her mom suffered for months before she died. My friend has so much guilt that her mother was unable to die the way she wanted. I think it’s really important that we have a talk about how we can prevent this from happening to anyone in our family.”