How to die with dignity not so easy to decide

My husband and I don't have living wills - those instructions specifying what actions should be taken for our health in the event that we are no longer able to make decisions due to illness or incapacity. We've talked about our wishes informally but have mostly left it at that. It turns out we're not alone, according to social psychologist Peter Ditto, PhD, of the Unviersity of California, Irvine, who says only about 25 percent of Americans have some kind of living will or advance directive in place. He presented several of his research findings today at a presentation titled "Is the Living Will Dead?" 

Ditto says people should not fill out living wills on a whim when they have a few minutes to spare. "Writing advance directives is a complicated psychosocial process," he said. "And it can be a rocky road to get others to honor someone's wishes."

For example, just getting someone to make definitive decisions about their own health is a major challenge. In one study, he asked people how much leeway they would want their loved ones to have when the time comes.  He found that only 9 percent wanted their wishes to be followed exactly, while 38 percent said they would be OK with a little leeway, 28 percent said a lot of leeway was fine with them and 25 percent said they would want their loved ones to have complete leeway. "People just don't want to micromanage their own death," Ditto said.

Ditto supports the provision in the Obama healthcare reform bill that would allow insurance companies to cover voluntary end of life discussions between doctor and patient. It was this provision that was often mischaracterized as "death panels" in the conservative media, said Ditto. He also cited a New England Journal of Medicine study that showed end of life discussions lower healthcare costs and improve quality of death.

Psychological science is still working to figure out the best way to help people make these decisions but, in the meantime, this discussion made me realize that, while it may not be easy, my husband and I should have a more in depth conversation about our end of life wishes.

More information on this research can be found on Ditto's website.

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