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Elder Care News
End-of-Life Planning Influenced by Education,
Religion, Death of Loved One
Researchers probe senior citizen planning for final
care
 June 7, 2007 - As a brain-damaged woman named Terri
Schiavo lived her final days in 2005, her family's bitter feuding
imparted a tragic lesson about the importance of specifying one's wishes
for end-of-life medical treatment. Yet, beyond headline-grabbing cases
such as Schiavo's, what truly motivates people to plan for medical care
at life's end?
With record numbers of Americans - the Baby Boom
generation - now reaching age 60, we still know surprisingly little
about these decisions or the factors that shape them, says University of
Wisconsin-Madison sociologist Deborah Carr.
A study by Carr and her Rutgers University
colleague Dmitry Khodyakov now offers insight into a critical aspect of
end-of-life planning: the choice to appoint a "health care proxy" who
will make treatment decisions should a person become incapacitated.
Writing in the June issue of the Journal of Health
and Social Behavior, the researchers report that education, religious
attitudes and experience with a loved one's death - especially a painful
death - are all powerful influences on this decision.
The findings have important implications for
policies and practices designed to encourage people to name a proxy,
also known as a "durable power of attorney for health care" (DPAHC).
Federal law currently mandates that patients
entering a federally funded hospital or clinic be asked whether they
have a DPAHC or a document called an advance directive. Medical
personnel will also sometimes discuss the issue with patients; however,
they tend to employ abstract arguments or ask patients to imagine their
future state of health, says Carr.
Her study suggests instead that having people
recall a loved one's death and their feelings about it may be more
convincing.
"Our results speak to the power of real world
experience," says Carr. "Abstractions, literature, handouts are all
great. But in the end, I think people respond more to visceral,
emotional factors."
Carr and Khodyakov based their analyses on data
from the Wisconsin Longitudinal Study (WLS), a unique 50-year study of
more than 10,000 men and women, now in their mid-60s, who graduated from
Wisconsin high schools in 1957. In 2003-04, a random subsample of more
than 7,000 WLS participants completed phone interviews and mail
questionnaires that probed their plans for end-of-life care.
Slightly more than half, or 53 percent, had named a
health care proxy, the researchers found. People who had attained some
college or a college degree were more likely than high school graduates
to have a DPAHC. So were those who believed they could confide in a
family member.
Personal beliefs also played a strong role.
Conservative Protestants were only 65 percent as likely as Catholics to
have executed a DPAHC. And not surprisingly, the odds of naming a proxy
were lower for individuals who scored higher on a measure of "fear of
death."
The study further examined whom people chose as
their DPAHC. The overwhelming majority turned to either a spouse or
child. But Carr and Khodyakov also recorded more than 25 different
choices, including siblings, co-workers, clergy and physicians. Most of
these idiosyncratic responses came from people outside traditional
married relationships who had no kids.
"This suggests that when people have innovative
family lives, they have to innovate about end-of-life issues, as well,
because they can't just knee-jerk go to a spouse or a child," says Carr.
With nontraditional families on the rise, she adds, "It's important for
practitioners to think about family in an expansive way."
In the future, she hopes to explore another key
question: Does end-of-life planning do any good? The assumption now is
that having a DPAHC will reduce family suffering and ensure the loved
one's wishes are carried out. But the true effectiveness of people's
choices has yet to be examined.
"It's possible that bad planning is worse than no
planning," says Carr. "Just because you name someone to make decisions
for you doesn't mean they can do a good job, and it doesn't mean they
have any clue what your preferences are."
That's why it's crucial for people to weigh their
options carefully and honestly.
"The fact is, not all people go to their immediate
next of kin," says Carr. "So, if you think the best representative for
you is someone who's down the chain of command - maybe not a spouse, not
a child, but a cousin or a friend - by all means, go with it."
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