My mother, of blessed memory, died peacefully at home at age 60 of progressive ovarian cancer. She died in 1984 according to her wishes, surrounded by loved ones in the familiar intimacy of her home. Fortunately, my mother discussed with us her desires and documented them in a “Living Will” prior to her death.  Characteristic of how she lived, she took good care of her loved ones by sharing her preferences with us so that when the time came to make difficult choices, we could be comfortable knowing we were acting according to her desires. She clearly articulated her wishes, helping us separate what she wanted from what we wanted (for her to live forever).

A number of years ago, my wife and I, thinking about our children, wrote a financial will and also discussed our preferences in the event we became unable to communicate our wishes regarding medical care. We translated these conversations into formal “living wills” (now called “Healthcare Directives”). Based on my experience with my mother, as well as caring for many patients and families at end of life, clearly stating my preferences represents a gift to my loved ones.

Benjamin Franklin famously said “in this world nothing can be said to be certain, except death and taxes.” How fitting that this year’s Tax Day, April sixteenth, is also National Healthcare Decisions Day (NHDD). NHDD is committed to ensuring all adults with decision-making capacity have the information and opportunity to communicate and document their healthcare decisions.  The healthcare collaborative sponsoring NHDD suggests Americans understand that making future healthcare decisions includes identifying preferences, clarifying values and selecting an agent to express healthcare decisions if patients become unable to communicate.

We have room to improve. According to a TIME/CNN poll, 7 out of 10 Americans indicate they want to die at home. However, three-fourths die in medical institutions. A 2005 AARP Massachusetts survey found almost 90% of respondents state physical dependency would be worse than death, with about 70% indicating that being unable to communicate their wishes or living with great pain is worse than death. Yet, only 29% of older adults have Advanced Directives.

We have the opportunity to model conversations about end of live values and preferences. I encourage you to begin this conversation with loved ones, especially if you are in the role of advising patients and families about healthcare directives.  Honoring Choices Minnesota provides support in several languages, including forms for Healthcare Directives.

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