Most people avoid thinking about death, let alone planning for it. Yet, without careful preparation, individuals risk prolonged suffering through unwanted medical interventions – unnecessary surgeries, ICU stays, or feeding tubes extending life without quality.
The conventional advice is to document preferences in a living will, ensuring doctors honor wishes even when mental capacity is lost. According to AARP, this puts you “at the captain of your own ship.” Such documents can specify whether you want CPR, ventilation, or artificial hydration under certain conditions.
However, this approach may backfire. Detailed advanced directives can be ineffective and even harmful. The problem lies in asking individuals to predict preferences for situations they’ve never experienced, without the context that would matter when seriously ill. Do you really know if you’d want a ventilator? Would your decision change depending on your mental state?
Furthermore, strict directives can obstruct family and clinicians when a different path seems better. Imagine refusing ventilation in writing, then suffering a reversible respiratory event. Would you want medical teams to hesitate when a short trial could restore your health?
A Johns Hopkins study revealed that patients who meticulously documented end-of-life preferences were more likely to receive aggressive, potentially burdensome care near death. This seems counterintuitive, but it illustrates the problem: rigidity can override good judgment.
The more effective strategy is simpler: designate a trusted advocate. Document in your medical chart who should make decisions if you can’t. Choose someone you trust implicitly, and tell them you trust their judgment. Do not ask them to follow a rigid script of what you would want in an unpredictable situation. Instead, empower them to decide what’s best, consulting with doctors and loved ones.
The author’s wife knows he doesn’t want life prolonged at all costs, especially if it means a permanent coma. Yet, he trusts her to weigh options, even if she wants to wait a few months to see if the condition truly is irreversible. His wish is for her to make the best decision, considering all circumstances.
Avoiding death planning is understandable, but essential. Designate someone you trust to make decisions when you can’t – and make it clear that you trust them to do what’s best.
