RATANGEE: It’s never too early to complete an advance directive

Our safety has never been guaranteed. But recent funding and personnel cuts have put all Americans, including students, at increased risk. In Wisconsin, Milwaukee, schools shut down amid an ongoing lead crisis and were denied assistance by the Centers for Disease Control and Prevention due to the elimination of vital divisions responsible for managing certain crises such as this one. Across 30 states and counting, over 1,000 cases of measles have been reported — nearly 30% of which have affected individuals over age 18. Americans, from 17-year-olds to middle-aged adults, are increasingly dying from the flu. And as gun safety laws and initiatives, like the White House Office of Gun Violence Prevention, are dismantled and campus shootings continue, we’re reminded even more so of our mortality.

While we shouldn’t accept these preventable causes of death, we should prepare for potential end-of-life scenarios, which we can do by using advance directives. An advance directive is a legal document consisting of two components: a living will for documenting one’s treatment preferences and a durable power of attorney for healthcare for granting decision-making authority to a loved one should you become unable to express those preferences.

Just over one in three American adults have completed an advance directive; among young adults, this completion rate drops to a mere 15%. Yet, when surveyed, a majority of young adults said they view advance directives as important and believe their similarly aged peers would be willing to complete one.

Most young adults surveyed also stated that they prefer maximal interventions for life-sustaining treatment and care, the default when no advance directive is present. However, it’s well-established that serving as a surrogate decision-maker for a loved one can cause undue stress and anxiety, even when end-of-life is expected. For a young person whose hospitalization or illness is unexpected, the absence of an advance directive only exacerbates this stress and uncertainty — and may result in care that doesn’t align with one’s preferences.

It’s also true that not every scenario of incapacitation or severe illness can be predicted. Even so, having informal discussions about one’s desired treatment and, importantly, following up these discussions with formal documentation allows you and your loved ones a greater sense of agency and reassurance should such a circumstance arise.

Some may argue that young adults are not ready to discuss these issues. Yet, let’s consider one rite of passage into adulthood: getting your driver’s license. It’s at this time that teens and young adults are first asked about the wishes of their future self: “Do you wish to be an organ donor?”

It’s a simple yes or no. Some opt in, hoping that they’ll at least be able to help someone else. Others opt out — indeed, it’s difficult to confront one’s mortality at such an early age, especially when life just seems to be picking up. But if we’re already asking about organ donation preferences, it isn’t that far of a step to engage in advance care planning. If not now, then when? 

Furthermore, with a sizable proportion of Vanderbilt students pursuing careers in health and medicine and working to promote the well-being of our campus and Nashville communities, it’s vital that we don’t neglect our own health and well-being. 

At the heart of American culture is our individualism, and medicine strives to protect and promote that autonomy. As preferences evolve, so too can one’s advance directive. But failure to complete one leaves our fate out of our hands and risks harming those dearest to us. With nothing to lose and much to gain, complete this preparation sooner rather than later — your future self just might thank you.