“Dying in America” Study: Americans endure unwanted care near death

​A newly released study from the Institute of Medicine has found that many Americans undergo unnecessary, costly treatment towards the end of their lives. The study authors concluded that this is largely a result of two forces: a natural hesitation to begin often difficult conversations about the kind of care we want at the end of our lives, plus the “perverse incentives” within our medical system which push doctors towards overly aggressive treatments.

So how do living wills fit into this not-so-pretty picture? A living will, also known in North Carolina as an “Advance Directive for a Natural Death,” enables you to specify when you want to stop receiving life-sustaining measures. It applies when you are approaching death and aren’t able to tell the doctors what you want – for example, when you are in an irreversible coma or you have an advanced, incurable illness that will certainly cause your death soon (such as cancer). This means that you can require your medical provider to take you off life support, feeding tubes, and antibiotics when it is merely drawing out the inevitable – death. Instead of receiving costly and pointless treatments, you can provide that you would rather have a natural death, being made as comfortable as possible.

For those of us who want to be sure that we will avoid unnecessary and costly end-of-life care, this is pretty powerful stuff. But, as this study acknowledges, simply signing a Living Will is no guarantee that your doctors will follow your orders. Medical institutions are incentivized to provide as much treatment as possible. Doctors are scared of getting in trouble – and in today’s litigious environment, it’s not hard to understand why. And family members, too, can be hesitant to carry out your wishes when they aren’t yet ready to let go.

This means that living wills aren’t an instantaneous solution to avoiding an unnecessarily drawn-out death. But they are essential to help your loved ones know your wishes. They provide guidance to your family members at an extremely difficult and emotionally draining time, and they provide doctors with legal grounds to cease treatment. And if you initiate conversations with your family and your medical providers about why you chose to execute a living will, you can prepare them ahead of time to carry out your wishes. Family members who know how much this means to you and who have the legal documentation to prove it are much more likely to follow your wishes. Medical providers who are on the same page as you about what type of care you would like to receive are much more likely to step back from their default mode of keeping patients alive at all costs.

Executing a living will is an essential first step if you want to die as naturally as possible. It’s not perfect, but if you execute a living will, provide a copy to your family members and doctors, and engage in meaningful conversations about what this means for you, you greatly increase your chances of getting the care you want even after you aren’t able to describe your wishes anymore.

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