More than 70% of Americans have made an advance directive, also known as a living will. According to a study in this month's Journal of the American Geriatrics Society the figure has risen from 47% to 72% in just 10 years. If you are in denial about your eventual fate, please read no further. To make an advance directive you need to think about dying. An advance directive should state what medical treatment you do not want to receive, should you become incapacitated. As long as you can think and speak for yourself, it doesn't come into play as you will be able to refuse treatment for yourself. Incapacity is defined by the Mental Capacity Act of 2005 and under this act an advance directive is legally binding in England and Wales.
Comparable figures for England (the laws are different in Scotland and Northern Ireland) are not available, but Macmillan's excellent online resource for making your own advance directive has been downloaded 12,000 times in just over a year. Macmillan prefers to talk about advance care planning because how you want to die should only be one part of your advance directive. By discussing your preferences with your family and healthcare professionals, you can plan everything from the care you wish to receive to who should look after your cat if you have to be hospitalised. So should you face your own mortality, or just bury your head in the sand and carry on thinking that you will live forever?
The solution
The US study says that there is good evidence that advance directives make it more likely that people will receive the care they want and be less likely to die in hospital. But it can be hard for someone to anticipate what medical treatment they would and would not want in a given situation.
Macmillan gives the example of whether a person would want to be kept alive by feeding tubes or drips if they were unable to swallow normally and had terminal cancer. Healthcare professionals would, however, challenge a directive if they felt that medical advances had been made in the time since it was written and that newly available treatments would be in the patient's best interests.
Different organisations provide different formats to fill out. Some ask you to pick from a list of medical conditions ranging from "serious but treatable" to "vegetative state", then ask you to specify the amount and type of care you would want in each scenario. Care levels range from "treat everything" to "comfort care" only. Macmillan advises that we have these conversations with relatives before we get ill and with healthcare professionals if we already have a serious condition. This way, we avoid people making assumptions about what we might want if we become unable to speak for ourselves. Barack Obama has made one and so has his wife. With that level of endorsement, it's clear that we should all think about our advance care planning.
