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THE CASE OF TERRI SCHIAVO

Information on Living Wills and Advanced Directives

Barriers to Doing Advance Care Planning

You will meet with reluctance to starting the planning process. You cannot make someone do what he or she is not ready or willing to do, but you can plant the seeds by showing them that there are real advantages to early advance planning and potential dire consequences to putting it off.

A strong argument in favor of early planning is the well-known fact that we are living longer. Because older adults are more likely to develop impaired decision making capacity than are younger people, it is important to assure that advance directives have been executed early. When patients communicate their wishes ahead of time, it decreases the chance of future conflict, decreases the potential for ethical dilemmas and takes the burden off the family and healthcare team. The sense of control and peace of mind that this process fosters in the individual and the reduction of anxiety of the surrogate decision makers are important benefits.

Although Florida law has a living will statute and supports the appointment of a health surrogate…

and the Patient Self-Determination Act requires that all health care facilities that receive Medicare payments inform patients of their rights to complete advance directives…

and insurance companies and regulatory agencies see advance directives as quality indicators

and we will all die someday from a variety of diseases for which medical science now has a wide spectrum of treatments

and we are living longer, thereby increasing the possibility of mental incapacity;

There are still barriers to fulfilling the intended goals.

Some of the obstacles to fulfilling advanced directives include:
  • The vagueness of the language does not, in all cases, guide treatment;
  • Surrogates may not be aware of the person's most recent wishes;
  •  Physicians do not bring up the conversation;
  • Physicians have difficulty breaking bad news;
  • No one wants to give up "hope;"
  • Anticipated disagreements between doctors and the patient and family;
  • Medical/legal concerns;
  • The belief that healthy people do not need advance directives;
  • Time–by the time the need is recognized, it is too late.

It is not within your power, or the healthcare system's power, to overcome all the barriers that hinder the proper execution of the dying person's wishes, but you have an opportunity to help the members of your faith community overcome the personal barriers that prevent them from completing advance directives.

Personal Barriers to Doing Advance Directives

  • Belief that physicians should initiate discussions

  • Procrastination

  • Apathy

  • Belief that the family should decide

  • Family would be upset by the planning process

  • Fear of burdening family members

  • Discomfort with the topic

Exercise:
For each of the personal barriers identified here, discuss how you might help your community member overcome this concern:

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