Posts Tagged ‘advance directives’

10 Steps to Communicate Your End-of-Life Wishes



Communicating your end-of-life wishes is often among the most difficult conversations you can have with your family and loved ones. It’s also a conversation that many avoid until it’s too late.

The importance of clearly laying out your end-of-life preferences cannot be overstated, however. And doing so before you a suffer a life-threatening illness or other crisis will help reduce anxiety and doubt for family members who may be confused about final wishes that haven’t been clearly expressed.

Perhaps the most important question when it comes to communicating end-of-life wishes is, “how to do it?” Fortunately, there are a variety of steps you can take and proven methods that should make the process easier for you and your family. Getting started now, before it’s too late, should be a priority.

  1. Plan ahead

There’s no time like the present when it comes to letting your loved ones know about your final wishes is now. You can start by drawing up a living will that states your treatment and care preferences if you should ever be in a position where you can’t speak for yourself.

It’s also important to have a durable power of attorney in place that appoints one family member or other trusted person to make medical decisions for you in the event you’re unable to do so. Take all the time you need to reflect on what’s most important to you, then get the paperwork started.

  1. Be clear about what you want

It’s not easy to think about becoming too ill to make healthcare and other important decisions. But a critical injury or debilitating illness can happen to anyone at any time, and it’s vital to be clear about your wishes as soon as you can in case the unthinkable happens to you.

  1. Finding the right opportunities

While finding the right time to talk about your end-of-life issues can be a challenge, here are some events that can present opportunities to sit down with family and loved ones:

*Gatherings or time spent related to milestones such as the birth of a child, marriage, death of a loved one, retirement, anniversaries, etc.

*During holiday gatherings when many family members may be present.

*When creating your will or other estate planning.

*When a major illness requires that you or another family member move out of the home and into a long-term care setting – such as an assisted living community or a nursing home – or when a friend or family member is facing a serious illness or end-of-life situation.

  1. Talk often

It’s important to have end-of-life conversations early and to ensure that everyone understands your wishes. Moreover, your preferences may change over time and create the need for regular discussions on the subject.

  1. Ask permission

Again, discussing end-of-life issues isn’t necessarily easy, and it may make some of your family members uncomfortable. Asking your loved ones for permission before diving into the topic reassures them that you respect and honor everyone’s desires.

  1. Keep the purpose in mind

Your conversations with loved ones should address two important goals: making sure that your financial and healthcare wishes are expressed and honored, and providing them with the information and confidence they need to make future decisions.

  1. Find an Appropriate Setting

Find a quiet, comfortable place to have discussions about end-of-life wishes – preferably somewhere private and without distractions. A noisy restaurant or other public places is probably not the right setting to broach this tough topic.

  1. Be a good listener

Whether you’re discussing your end-of-life wishes, listening to another family member express theirs, or getting feedback from family and friends, it’s important to listen carefully. Make every effort to hear and understand what your loved ones are saying, and make clear to them that it’s important to you. If you’re listening to someone else,express their wishes, try to reaffirm what they’re saying and acknowledge their right to make life choices, even if you disagree with them.

  1. Know your audience

Some loved ones and family members may want to discuss end-of-life wishes in private rather than in a group setting. Use your knowledge of the people involved to figure out the best way express your wishes.

  1. Let others set the pace

If you’re in the role of listening to a family member express their wishes, follow their lead. Avoid correcting the person or becoming argumentative if they say something you don’t agree with.

Open for Interpretation: POLST Forms Versus DNRs

When it comes to end-of-life decision making, most people are very specific about their personal preferences, according to a recent article at But a standard DNR (Do Not Resuscitate) order falls short, leaving caregivers with the burden of interpreting their loved one’s wishes. DNRs are currently the standard used by most hospitals and skilled nursing facilities, but a growing movement is slowly replacing the DNR: POLST forms.

POLST forms go beyond the DNR

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POLST (Physician Orders for Life-Sustaining Treatment) forms go above and beyond, outlining specific measures to be taken under different circumstances. A person can specify, for example, that he wants to be treated with antibiotics for an infection but does not want a feeding tube. POLST forms have actually been around since the 1990s (and were developed in Oregon), but communities across the country have been implementing the program in recent years.

POLST: Overcoming limitations of DNRs and advance directives

Standard DNRs and advance directives can be difficult to locate in an emergency. POLST forms, on the other hand, were originally designed to be brightly-colored and travel with a patient. If a resident in a skilled nursing facility or assisted living facility is transferred to the hospital, for instance, the POLST form accompanied the patient so there’s no ambiguity regarding the individual’s preferences.

Today, however, the state of Oregon relies on an electronic database established in 2009 so practitioners have immediate access to a patient’s POLST form. And patients are free to completely revoke or modify their POLST forms at any time. To date, more than 70,000 Oregon residents have filed a POLST form, a dozen states have implemented POLST orders and 22 additional states have plans to do so.

Code status tells little about individual preferences

Standard DNRs (or advance directives) tend to focus solely on a person’s code status: Do you want to be resuscitated in the event that your heart stops beating, for instance. The answer for many folks is no, but these orders fail to move beyond this to specify individual circumstances and various types of treatment  options that could provide comfort or prolong life.

The problem is that many physicians and emergency personnel have a tendency to over-interpret a no-code status, meaning if they’re treating an individual with a DNR, they also won’t consider other treatment options, such as antibiotics, feeding tubes, comfort care or hospitalization. Under these circumstances, some individuals failed to receive treatment they may have wanted, or ended up receiving life-sustaining measures they would have opted out of if given the choice.

Researchers from Oregon found that about 72 percent of people in the registry (a total of 25,000 individuals) didn’t want CPR, but were in favor of other measures, including hospitalization, temporary feeding tubes and antibiotics to treat infection. In prior studies, it was discovered that patients with a no-code status were less likely to receive antibiotics or to be hospitalized, and in some cases, physicians were less likely to order lab work.

According to Dr. Steven Zweig, professor at the University of Missouri-Columbia School of Medicine, says POLST forms help create meaningful conversations about end-of-life care, noting that standard DNRs over-emphasize CPR without drilling down to other important preferences.