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Acceptors and Rejecters of Life-Sustaining Treatment

Because most patients are decisionally incapacitated at the end of life, health care providers often rely on advance directives or proxies’ substituted judgment for guidance in treatment decisions. In a survey of 202 older adults and their respective proxies, we compared older adults who would reject life-sustaining care to those who would accept it in terms of the availability and accuracy of the information sources that providers would consult, viz., whether the patient had (a) completed a living will, (b) designated a durable power of attorney for health care (DPAHC), and (c) discussed wishes with a proxy; and (d) we calculated the accuracy of proxies’ substituted judgment. Older adults who would accept all treatments were significantly less likely to have completed a living will, assigned a DPAHC, or discussed their wishes with their proxies, and their proxies were much less accurate in understanding their wishes.