Estate Planning: Advance Directives and Durable Power of Attorney for Healthcare

He, like Gawande, was a physician and as interested in dying well as he was about living life to the fullest. Several concepts are particularly worth considering:

The Importance of End-of-Life Conversations

End-of-life discussions are difficult, but research suggests they are profoundly important.

According to a 2008 Coping with Cancer study:

“Terminally ill patients who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die in peace and in control of their situation and to spare their family anguish.”

The Role of Hospice and Palliative Care

Hospice can prolong life with less suffering and often works best when started earlier.

A 2010 Massachusetts General Hospital study found that:

“Those who saw a palliative care specialist stopped chemotherapy earlier, entered hospice far earlier, and experienced less suffering at the end of their lives.”

Early integration of palliative care helps patients maintain dignity, reduce pain, and improve quality of life.

How Physicians Approach Death

Doctors often die differently from other patients, frequently choosing less aggressive treatments with low chances of success.

This reflects a broader understanding of quality of life versus quantity of interventions.

Healthcare Spending at End of Life

“25% of all Medicare spending is for the 50% of patients who are in the final year of life.”

This highlights the importance of thoughtful decision-making and advance planning.

Taking Control of Your Wishes

It is important to take control of your healthcare preferences early. Consider discussing your wishes with loved ones and professionals before a crisis occurs.

Gawande suggests including advance directives and legal planning such as a durable power of attorney for healthcare.

Key questions to consider include:

• Who do you want to make decisions on your behalf if you cannot?
• If time becomes short, what matters most to you?
• What are your hopes and fears about what lies ahead?
• How do you want to spend your time if your health worsens?
• How much treatment are you willing to undergo for a chance at survival?
• What level of quality of life would be unacceptable to you?

Closing Thought

We hope these ideas encourage reflection and meaningful conversations with loved ones.

In loving memory of Dr. Edward H. Gaston.