Importance of Health Care Directives

Q:  Every year when I have my annual check-up or have a scheduled medical procedure I’m always asked if I have an advance directive. I must admit I don’t. I know this is important but I keep procrastinating. Are other people as reluctant as I am to execute this document?

A: It is estimated two thirds of the adult population does not have a Living Will or other advance directive, so you are not alone. In fact, many people have not chosen someone to act as a Health Care Proxy. While most Americans who die are older and have a chronic disease, death can come at any age. Two of the most publicized “right to die” cases involved young people (Karen Ann Quinlan and Nancy Cruzan). It seems every year we focus a column on this subject so once again we encourage all individuals of legal age to take action and realize why this is important.

Understandably death is not an easy topic to address whether it is our own death or that of someone we care about. Reality is it is going to happen to all of us and we should be able to express our personal preferences regarding end of life care. Many people perceive an advance directive is all about “pulling the plug”. It isn’t entirely about what procedures you don’t want such as intubation, resuscitation or tube feeding. It also includes what you do want, for instance being kept pain free and comfortable.

There are numerous forms of documents which meet the legal requirements for an advance directive. One example is the Five Wishes, a helpful guide which addresses personal, spiritual, medical and legal issues all in a single document. It is accepted in 42 states (Massachusetts is one) and the District of Columbia. The document provides suggestions on how to initiate a conversation about end of life with family members or other individuals close to you and communicating your choices with healthcare providers. The document can be found on-line at


