Paul Malley Replies to AM News story (1/5/09)

Dear Editor:

The “Defective Directives? Struggling with End-of-Life Care” story (AM News 1/5/09) made many good points, but did not address why so few Americans complete advance directives. We’ve found one major reason is that so many advance directives are written in difficult to understand medical and legal terms that cause most people to give up. These forms don’t address things that people say matter most to them, like comfort, dignity, spirituality, and family relationships.

Another huge obstacle is that 10 states, notably Ohio and Texas, require lengthy warnings or specific statutory language that makes completing advance directives all the more difficult. Why do these states require you to use their words to express your own preferences?

Many physicians, large health systems and hospices use Five Wishes and report great success in both the completion rate and in improved doctor-patient communication. The document is written in plain English and is available in 23 languages and in Braille.

Our efforts to encourage advance care planning should revolve around a process that is understandable and meaningful for patients, families, and caregivers. This is a better alternative than requiring people to express their deeply personal intentions in state-mandated documents or forms written for the convenience of health care providers.

– Paul Malley, President, Aging with Dignity