About two-thirds of adults in the U.S. do not have any type of advance directive, according to a systematic review of 150 studies, which included data collected from nearly 800,000 people between 2000 and 2015. Such legal documentation—in the form of "living wills" and health care powers of attorney—allow people to communicate their end-of-life health care wishes, including the use (or not) of life-sustaining measures, should they become incapacitated due to illness or accident.
Published in Health Affairs in July 2017, the study found a similar overall prevalence of advance directives among healthy adults and those with chronic illnesses (33 percent versus 38 percent, respectively), with higher rates (about 50 percent) in people over 65 and in those who had neurologic disease or were under hospice or palliative care or in nursing homes.
Due to changes in 2016, Medicare now reimburses physicians for advance care planning conversations, which should hopefully increase the number of older Americans with living wills and designated health care proxies, assuming the policy remains in place under the Trump administration.
People with advance care directives are less likely to die in hospitals and more likely to receive the end-of-life medical care they want, prior research has indicated. But keep in mind that they are not always carried out for a variety of reasons: Living wills, for instance, can’t anticipate all medical situations, or the hospital or physician in charge may not comply with the directive. And the health care surrogate you appoint must be present and well informed of your wishes—which is why it’s important to talk to that person in advance, giving him or her the clearest guidance you can, and providing updates if you change your mind about certain care. Living wills should also be reviewed and updated as needed, since your views about end-of-life care may change over time.
It’s important to know your state laws. Most require that directives be signed by witnesses and notarized. Contrary to what many people think, only a few states consider oral directives legal. You can get more information about advance directives and print out free forms, by state, at the websites of AARP and other organizations. Some people may wish to get advice from an attorney.
Also see Dying in America.