In the article “Taking Responsibility for Death” by Susan Jacoby, she argues that there is a clear separation between the value American society places on personal choices during life versus choices made at end-of-life. It would seem that, as a society, we do not reinforce the importance of personal choices for when our untimely end reaches us, as much as we do to push the choice to be drug-free in society today. Susan Jacoby proceeds in her article to emphasize the importance and cost effectiveness of having an advance directive in order to safeguard what
“will” happen to you once you are no longer to make conscious decisions, or are at end-of-life moment.



The above video from the California Healthcare Foundation reflects on patients’ choices when it comes to end of life and how a physician’s order for life sustaining treatment (POLST) can provide great relief for patients at their end of life moment. The POLST is a bit more specific that the living will, in my opinion, because if this form is filled with the physician a lot of major concerns and questions can be answered. Ultimately, the goal is to get more people to have an advanced directive of some sort and remove the fear that many people face today about death and how it works.

Susan Jacoby mentioned her mother being in hospice care and how her directives were upheld as she received no artificial nutrition or a respirator. This described event showcases the simplicity of advanced directives and the ability to make your own choices for you end of life experience. Mrs. Jacoby also went into how the cost between hospice care and hospital care varies greatly and how such figures could be reduced. As humans we have a right to live and responsibilities as to how we live; on the other hand, we should have the right to die and with death there comes responsibilities as to how. I broke down the responsibilities that I believe people should have when it comes to end of life preferences into two categories: self-preference and financial preference. It would be the responsibility of the patient to think about what they would like to have done to them if they were in that life or death moment. Living wills, whether it is notarized or it was just written in  a journal, are better than nothing when it comes to deciding if you want to be kept living on artificial treatment  or having no treatment at all. The patient should be responsible to have a healthcare proxy as well in order to speak on your behalf and for your directives if on your living will.  Also, the financial aspect of end-of-life can be catastrophic with left over medical bills from treatments that may have been unnecessary and these costs would be left to the family to pay. Like what Susan Jacoby mentioned, these costs can be lowered if not avoided if more people become aware of the treatments they do/do not or want/need through living wills, POLST, proxies, etc.  With these measures established, patients’ and patients’ families should question any decision made by the healthcare provider. Anyone would like to know what is going to happen to them and even if you or the family doesn’t know enough about a subject, it shouldn’t prevent someone from trying to find out.

It would be the sole responsibility of the patients’ family to push the importance of advance directives with the patient and not fear that talk of “what happens if anything were to happen to you”. It’s also the family’s responsibility to provide optimal support and enforce the choices made by the patient on how they would like to be treated. The patient should speak up if the way that they are being treated doesn’t suit their needs and if they have a living will and no longer want to follow through with what’s on it, they can change it. End-of-life planning is one of the few things that is entirely up to you and how you approach it. It would be best to get information on how advance directives work and by increasing your knowledge of the responsibilities at end-of-life, one can feel more confident on the directives they choose.

Responsibilities at EOL



It is going to happen to us all, so why is it so hard for us to face the facts and share our preferences? Everyone is going to die, and I think that we all have a responsibility to make our own decisions regarding end of life preferences. Like Susan Jacoby said, Americans love having the freedom to make their own decisions, but are so reluctant to actually make them, especially when it comes to end of life preferences.

Susan Jacoby’s article made me realize how important it is for people to share their preferences at end of life. What happens if you are dying, you cannot communicate with anyone, and no one knows your end of life preferences? There is going to be fights between family members, and more importantly, no one will know what you want. All Americans should have an advance directive of some sort. Americans should either have a living will, appoint a health care proxy, or even just tell family members what they want. The problem is that no one wants to talk about it. No one wants to be having a cup of coffee talking about their end of life preferences. Americans just put off the topic until it is too late to know.

Patients need to fulfill their end of life responsibilities before it actually happens. Before they go into the hospital, patients need to have an advance directive. That way, everyone is sure of what the patient wants. The patient needs to hopefully try to enjoy spending time with family at end of life. The role that the families play in end of life is being there for the patient. After knowing what the patient wants, the family should be there to make sure the patient’s wishes are carried out the way they wanted, even if it is hard for the family to accept the wishes. The patient is the family’s main priority. If everyone knows the patient’s wishes, then it will make the end of life process a little less stressful.

The healthcare provider is there to carry out the patient’s wishes. If the family or patient ever feel like they need to question the healthcare provider, then they need to go ahead and question away. If the healthcare provider is doing something that the patient or family feels is not right for the patient, then they should ask questions. The patient and family should never feel not knowledgeable enough to ask questions. It could be helpful if the family did research so they could be somewhat prepared when the doctor spoke.

Just like Susan Jacoby said in her article, “Without advance directives, even a loving child may be ignorant of her parent’s wishes”. This is so true on so many levels. I think many problems with end of life care would be solved if every American could just have an advance directive. The end of life process would be much less stressful for the family and the patient.