Doctors and advance directives

If your loved
one and family have had the conversation about end-of-life wishes, kudos to you!
In addition to writing down those wishes in an advance directive, your relative
should also share them with his or her health care team.

Even if your
family member is in perfect health now, that could change at a moment’s notice.
It’s important to have the conversation with the primary care doctor and any
specialists while in relatively stable health. Not during a crisis!

Medicare will

Physicians are
reimbursed for having this discussion. Doctors don’t typically raise the
subject. But they do respond when a patient initiates.

Here are some

  • Scheduling. Make a special appointment for this
    conversation. Tell the staff that you want to discuss end-of-life decisions.
    That helps the doctor prepare.
  • Philosophy. Before the appointment, have your
    relative consider: Does he or she lean toward a “do everything”
    approach or prefer “no heroics, keep me comfortable, let nature take its
    course”? Anything he or she wants to be sure does NOT happen? Any
    religious beliefs or personal experiences—events with friends or family—that
    guide those wishes?
  • Advance
    If your
    relative has completed the form, make sure the doctor has a copy and it is
    included in the medical record.


The doctor may
inquire about specifics. Does your loved one want resuscitation? Tube feeding?
A ventilator? Ask about the pros and cons. What is the survival rate with each
procedure? And what might quality of life be afterwards? (Broken ribs from CPR?
Infections from a ventilator…?)

Your relative
needs to have this discussion with the doctor—and the family—while still able
to convey concerns and priorities. With end-of-life wishes, “It’s always
too soon … until it’s too late.”

Is this a
difficult subject to bring up?

You are not alone! As the Metro DC experts in family caregiving, we at Debra Levy Eldercare Associates understand that it’s a sensitive topic. We can help. Give us a call at 301-593-5285.