My mom paid a painful price for not completing an advance directive about her preferences for end-of-life medical care. She was an intelligent and organized woman who had everything in her and my dad’s life planned out and written down. She even drafted her own obituary. Ironically, she never discussed her end-of-life care goals with my father or her physician son (me), preferring to talk about “more pleasant subjects.”

As a result, after she developed colon cancer at age 86, my dad and I had to figure out how to treat her post-surgical medical complications of heart and renal failure. She died in hospice care after prolonged, unbearable and unnecessary suffering. It broke both my dad’s heart and mine.


Unfortunately, my mother’s story is all too common. Nearly one out of four older Americans (24 percent) say that either they or a family member have experienced excessive or unwanted medical treatment, the equivalent of about 25 million people, according to a poll conducted last year by Purple Strategies. A key reason for this problem is only about one out of six Americans (17 percent) say they’ve had discussions about their end-of-life health care goals, preferences and values with a doctor or other health care provider, according to a recent Kaiser Health Tracking Poll.

Evidence-based research overwhelmingly shows the need for more and higher-quality doctor-patient conversations about the patient’s health care goals, preferences and values. The report “Dying in America,” by the Institute of Medicine noted that: “Most people nearing the end of life are not physically, mentally, or cognitively able to make their own decisions about care … The majority of these patients will receive acute hospital care from physicians who do not know them. As a result, advance care planning is essential to ensure that patients receive care reflecting their values, goals, and preferences.”

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