Health-care preparation: Early, uncomfortable, necessary

Two months ago, I filled out a living will. I also signed a health-care power of attorney, which appointed a health-care agent. One month ago, I e-mailed the documents to my family and my doctors. Today, I'm still a healthy 28-year-old, but one with an advance health-care directive posted on my refrigerator.

My advance directive specifies health-care instructions if illness or incapacity prevents me from communicating. Composed of two parts, my living will provides guidelines for treatment based on my wishes, and my health-care power of attorney authorizes my chosen health-care agent to make sure they are followed. Yet, despite the availability of these legal mechanisms to protect the ability to control end-of-life care, I'm joined by only about one-third of Americans in having them.

It's likely even fewer Americans have an accurate advance directive included in their medical records. Locked in an inaccessible drawer for "safekeeping," or long forgotten and outdated, these documents are rarely available when necessary. The result is family members often make difficult care decisions about nutrition, palliative care, and perhaps, ultimately, organ donation while influenced by emotion and forced to speculate about personal preferences.

The problem is conversations about end-of-life care can be just as difficult as the decisions. I resorted to e-mail to communicate with family members because they preferred to avoid a conversation that was "morbid" and "premature." When we finally sat down, the discrepancies between what we each considered a "good death" were staggering and seemingly influenced by age, experience, and trust in medicine. And though my family members still might not understand some of my choices, they understand how important respecting those choices is to me.

Forcing such conversations might be one way to increase the completion of advance directives. Nurses in La Crosse, Wis., ask each hospital patient about treatment preferences, and the result is that 96 percent of that population has some form of advance-directive documentation.

The bill that ultimately became Obamacare initially provided funding for hospitals to implement such end-of-life consultations, but fears of "death panels" stirred up by some politicians, including presidential contenders, stymied rational discussion of it. Fast-forward to the current election cycle, and potential presidential candidate Jeb Bush supports requiring all Medicare beneficiaries to fill out an advance directive in order to receive benefits.

Regardless of the catalyst for conversation, discussion and advanced planning for end-of-life care can be cathartic. When the time comes, all that's left unsaid is "goodbye."