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Advance Directives Help Assure End-of-Life Wishes Are Honored
Date:3/31/2010

es are documents that list your end-of-life care wishes (a living will) or who you would like to make those decisions for you if you are incapacitated (durable power of attorney for health care).

Silveira said that whenever someone enters a hospital or care facility, he or she is given the opportunity to complete an advance directive, which is one reason why so many elderly people may have these documents.

The problem, however, is that many people will designate a health-care proxy or prepare a living will and then tuck the document away without discussing it.

"People need to have conversations with the person they've appointed, not just put the document in a locked safe deposit box," said the author of an accompanying editorial in the same issue of the journal, Dr. Muriel R. Gillick, a clinical professor in the department of population medicine at Harvard Pilgrim Health Care Institute and Harvard Medical School in Boston.

Silveira's study included 3,746 people over 60 years old who died between 2000 and 2006. The vast majority of people with living wills -- 92.7 percent -- wanted only limited care at the end of their lives. Slightly more than 96 percent said they'd prefer comfort care. Only 1.9 percent requested all care possible.

The researchers found that 83.2 percent of those who requested limited care and 97.1 percent who asked for comfort care received the care they requested.

"People should be reassured [that] if they complete advance directives, they get what they want most of the time," Silveira said.

Gillick said she recommends designating a health-care proxy to make decisions for you, and to have a non-legal letter expressing your more specific wishes for medical care. She said the problem with many living wills is that they're too generic.

In her editorial, Gillick said, "The ongoing challenge is to transform advance care planning from the act of signing a form to a proc
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