Only 29 Percent of Americans Have a Living Will: Advance Care Planning is Critical Regardless of Your Wishes

You are in an accident. You are rushed to the hospital as emergency personnel work to keep you alive. The doctor tells your family that you are unconscious, your prognosis is poor and death may be eminent. You are attached to a ventilator through a breathing tube since you cannot breathe on your own.

A week later, the doctor states that there is no chance of recovery and it is unlikely you will ever wake up. Your family is asked whether or not to insert a feeding tube in your stomach to provide you with nutrition and hydration and a permanent tube through your throat to keep you breathing.

One of your family members says "no tubes" because of a conversation about Terri Schiavo that the two of you had. Another one says "yes" because of their own spiritual beliefs. You never completed an advance directive: So who makes the decision?

Most people would emphatically agree that an individual should have the power to make their own healthcare decisions. Ironically, most Americans have not taken steps to make sure their wishes are known or honored reports the National Hospice and Palliative Care Organization. The tragic situation involving Terri Schiavo was made all the more difficult because she had no written advance directive.

A recent study by the Pew Research Center for the People and the Press found that although more than 70 percent of Americans had given thought to end-of-life treatments, only 29 percent have a living will.

"Every day, families are faced with difficult decisions regarding a loved one's care and far too often decisions are made without a clear understanding of what the patient would have wanted," remarked J. Donald Schumacher, president/CEO of the National Hospice and Palliative Care Organization. "Imagine how terrible it would be to see your loved ones arguing over your medical care decisions when they are already struggling with circumstances that are tragic enough. Advance care planning could make a difference."

Completing a living will, or an advance directive, is part of advance care planning. It lets you explain the kinds of care you would and would not want if you were ever seriously ill. A healthcare power-of-attorney is another part of an advance directive that lets you appoint someone to make healthcare decisions on your behalf if you cannot speak for yourself.

Planning is important whether you want every life-sustaining medical intervention available up until the moment of your death, or if you want to spend the final period of your life focusing on comfort care. What matters is that you make your wishes known by completing an advance directive and talking about it with your loved ones.

"In the past year, more than 1.5 million people have downloaded an advance directive from our Web site, caringinfo.org," Schumacher added. "We have also mailed out another 50,000 directives to people who have called our HelpLine. But it's not enough to get a hold of a directive -- you must fill it out and talk openly with your loved ones."

March 2006 is the one-year anniversary of NHPCO's Caring Connections consumer engagement initiative. The organization is urging Americans to wear a white ribbon, especially on March 31 (the anniversary of Terri Schiavo's death) to promote advance care planning.

Caring Connections, a program of NHPCO, provides free state-specific advance directive documents and information about advance care planning as part of the "It's about how you LIVE" campaign to improve end-of-life care. Caring Connections also offers information flyers to help people talk with loved ones, ask questions of their doctors, and understand the range of issues involved in care at the end of life.