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Why Advance Care Directives Are So Important

Why Advance Care Directives Are So Important

A while back I had written a blog post on how important it was to have end of life conversations with those that are nearest and dearest to us about the decisions we want made on our behalf regarding our care.

The article that sparked my post was a blog post published in the Journal Of Medicine titled “Doctors Die Differently; It’s Not Like the Rest of Us But Should Be.”. In this article, a doctor shared his perspective on how physicians personal end of life decisions would be very different than how they actually treat their patients.

Given a physicians unique experience of being so close to people when they die I imagine that they may have a much different perspective than the majority of us and in turn their personal end of life treatment requests are different.

And this is true. In some recent research conducted by Stanford University they studied how physicians would want to be treated at the end of their own lives. What was interesting in this research was that 88.3 percent of the doctors surveyed said that they would choose “no-code” or do-not-resuscitate orders for themselves.

So why is it so different for doctors than for ourselves? Why do we seem to want / or are provided care at the end of our lives that might be deemed excessive?

In an article written by Jonathan Kay in the National Post titled Canadian Doctors Explain Why So Many Of Us Die Badly, he examined this issue and through discussions with healthcare providers discovered that there may be some unique occasions where a physician may recommend excessive treatment however many believed the majority of time it was the family’s decision of how an individual was treated at the end of their lives that determined what was done.

To quote one of the healthcare providers in the article;  “We have been conditioned, as a society, to want to preserve life at all costs.” So it seems even when there is no hope for recovery or improvement, many families are still actively pushing for something to be done.

So maybe our physicians aren’t necessarily the ones deciding our end of life plans but it is our families that seem to be pushing for action – and these requests may be without direction from the individual themselves.

According to a 2010 draft framework for advance care planning, the Canadian Hospice and Palliative Care Association found that the majority of Canadians support advance care planning but in fact a relatively small number of Canadians actually plan for it. In a poll that was conducted in 2004, they found that;

  • Eight in ten Canadians agree that people should start planning for end of life when they are healthy.
  • 70% of Canadians surveyed have not prepared a living will.
  • 47% of Canadians have not designated a substitute decision-maker to make healthcare decisions for them if they are unable.
  • Fewer than 44% Canadians have discussed end-of-life care with a family member.
  • Although Canadians feel that end-of life care is an important discussion to have with a physician, only 9% have done so.

And it’s becoming more critical that we make these plans when we are healthy enough to do so. For example, according to the Toronto Alzheimer’s Association, in just 5 years as much as 50% more Canadians and their families could be facing Alzheimer’s disease or a related dementia. Without advance care planning in place, this could leave families forced to make decisions about their family members care without any guidance on what they would have wanted.

So what do we need to do?

The Canadian Hospice Palliative Care Association launched a “Speak Up” campaign to help families discuss and document their advance care directives. On their website, they have provided information, resources and tools to help families have discussions, make decisions and document their wishes before any need arises. You can access their website here

As one of my friends said, having the discussion initially was difficult as no one likes to talk about death or even think about leaving their families but once it was done you feel confident that everyone knows what you would have wanted should they have to make any decisions on your behalf.

I guess having an advance care directive is sort of like having insurance – you hope you won’t ever need it but it’s there if you do. 

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Susan Williams is the Founder of Booming Encore. Being a Boomer herself, Susan loves to discover and share ways to live life to the fullest. She shares her experiences, observations and opinions on living life after 50 and tries to embrace Booming Encore's philosophy of making sure every day matters.