It's a paradox of American health care that has been present for years, and a new study reinforces it: the overwhelming majority of Californians say they want to die a natural death, at home, but less than one in four has actually put their wishes in writing. This lack of clarity can leave loved ones and doctors to try to sort out wishes, often during a time of crisis.
The statewide survey is from the Oakland-based California HealthCare Foundation. While so few have put their wishes in writing, the poll also found that 82 percent of Californians said it was important to do so. Another paradox.
"When we juxtapose that to what actually happens to people," said Kate O'Malley, senior program officer at the Foundation, "We realize there is a lot of work to be done in helping people find a way to state their preferences and make sure that their family members and their providers know what their preferences are."
The survey, Final Chapter: Californians' Attitudes and Experiences with Death and Dying, found many other wide-ranging disparities between what people said they wanted and what actually happened:
- 70 percent want to die at home, but 32 percent actually do so; most die in a hospital or nursing home
- 60 percent do not want family members burdened by tough decisions, saying it's "extremely important," but fewer than half have talked to loved one about personal wishes
- 8 in 10 say if they were seriously ill, they would like to talk to a doctor about their treatment wishes, but only 7 percent have done so
On this last question of doctors and patients talking about end-of-life wishes, Kate O'Malley pointed to a chicken or the egg problem. "There was one study that showed that 75 percent of patients wanted to talk about this and were waiting for their doctors to bring it up," she said. "Then when they (researchers) talked to the doctors, they found that many of them wanted to talk to their patients about this, but they were waiting for their patients to bring it up. So there's this question about what is the right moment?"