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One of the themes In SAGE’s Successful Aging program is “Preparation.” We define the term as: “Doing what you can, when you can, in advance of and addressing aging related contingencies.” This naturally includes completing wills and all the other related documents, such as living wills and advance directives. But according to a recent article in the New York Times entitled “The Trouble with Advance Directives”, completing the documents may not be preparation enough. For the documents to be effective, treatment providers have to know of them, and what they say.

The article describes a man whose advance directive specified “comfort care only, no heroics.” Not knowing the document existed, much less what it said, his doctors put him on a ventilator, performed a tracheostomy, and inserted a feeding tube. These procedures were approved by the man’s son, who was also unaware of the advance directives, and had never had a conversation with his father about the subject.

The Times article makes clear that getting the documents prepared and signed is only the first step. “Stories abound of documents misplaced, stashed in safe deposit boxes, filed in lawyers’ offices.” Or, as was the case with the case they described, the documents could be in the individual’s file, and were never discussed with family or medical staff.

Even when they’re consulted, the document’s language may prevent ready implementation. If it uses vague or outmoded language (what’s a “terminal “ condition? How long must a “vegetative state” last to qualify as “persistent”?), medical personnel may not be clear about how to proceed.

The best thing “experts say, is an ongoing series of conversations with the relatives or friends who will direct their care when they no longer can. In a crisis, doctors will turn to those people — more than to any document — to learn what the patient wants.”

Preparation, therefore, isn’t just about getting a document signed. As the article concluded, “People feel reassured, even downright virtuous, when they have completed their paperwork, ‘but if the family doesn’t know about it, if the medical team doesn’t know about it, it might as well not exist.’”