Why don't people complete advance directives?

by Paul Malley

It's a great idea to legally designate someone who will make health care decisions for you in case you become seriously ill and can't speak for yourself. It's also a great idea to give this person clear direction so he or she can best act on your behalf. As with so many great ideas, too few people follow through and complete an advance directive (“living will”), even though doing so brings tremendous peace of mind. Why so few?

Of course the topic of illness, life support and death are difficult ones to raise (“Mom, if you ever go into a coma, do you want a feeding tube, a respirator, or both?”) or for some, even contemplate. Another reason is that many advance directives, particularly the government-supplied forms, are jammed with often confusing medical and legal jargon and pages of difficult to understand instructions. Most people just give up.

Some states make their residents jump through additional hoops. Ohio mandates a verbatim 1,700-word Miranda-like warning, the longest such notice in the nation. Forms without the word-for-word disclosure are not considered valid. In Oregon, the state endorses your right to ask your doctor for suicide drugs, but not to use your own words to direct what kind of treatment and pain management you would want.

Fortunately, at least 42 states have found it's better and more effective to allow their residents to use their own words to convey their wishes, designate their health care agent and describe what quality care means to them. More than 18 million people rely on the Five Wishes advance directive, which covers the medical and legal issues, but also touches on personal, family, comfort, dignity and spiritual matters – the things people say are most important.

Five Wishes is written in plain language and is easy to understand and use. For those whose language is not English, Five Wishes is available in 25 other languages. When you complete Five Wishes, you now have a plan. You've also given a gift to yourself and to your family members by clearly communicating what you want and don't want in case of serious illness.

As President Obama and Congress embark on comprehensive reform of the health care system, a good place to start would be to affirm your basic right to express your health care decisions using your own words, not the government's words or on forms written for the convenience of health care providers. Decisions about medical treatment in times of serious illness rightly belong in the hands of patients and their families. These decisions are too important to be left to government officials, insurance companies or other third parties.

(Paul Malley is President, Aging with Dignity, a national non-profit organization that created and distributes Five Wishes. For more information, go to www.agingwithdignity.org or call (888) 5-WISHES.)