University of New Hampshire
Mentor: Dr. Raelene Shippee-Rice, Associate Dean for Research, School of Health and Human Services
"I Don't Want No Machines Prolonging My Life": Elders Understanding of Advance Directives
Studies have shown that most individuals do not have living wills (a document that states under what circumstances you want treatment or intervention used or discontinued, and is only effective if someone is terminally ill or near death) or durable power of attorney for health care (a document that allows a designated person to make medical decisions for you, if you are unable to communicate) provisions in place (High, 1993; Patterson, et al, 1993). It is unclear why this is so, although individual spiritual, cultural and personal values may have some bearing on this (Sherman, 1997; Wetle, 1994). For elders in particular, completing such documents may result in a great deal of emotional discomfort as they face their mortality, preferring to leave end-of-life medical decisions to their families (High, 1988).
This exploratory study examines the knowledge and perception elders have of the living will and the durable power of attorney for health care. Twelve elders were interviewed in an effort to discover the following: 1) knowledge of advance directives, 2) communication of end of life decisions with their families, 3) dialogue of end of life decisions with their physicians, 4) feelings of understanding and acceptance of their decisions by family and physicians, 5) intent to sign or not to sign advance directives, 6) reasons for making the decision to sign or not to sign advance directives.
The findings of this study indicate that there is a great deal of confusion about the living will and the durable power of attorney for health care. Initial findings also suggest that conversations about the living will and the durable power for attorney for heath care are usually initiated by someone other than the elder, usually a family member, an educational program, a hospital or nursing home. Finally, this study indicates that elders are unclear as to the purpose and value of these documents. This study also supports previously published works that indicate advance directives (the living will and the durable power of attorney for health care) are not being completed by many elders (Soskis, 1992; Freedman, 1994). Based on these findings, recommendation for social work practice, community education and health care policy are provided.