Of course it’s not easy to think about how our lives might end — much less talk about it. But Americans are pretty good at sidestepping the whole issue of end-of-life care, despite the fact that their comfort — or survival — could depend on it.

But according to a new report from Kaiser Health News, only about a third of U.S. adults have taken the time to set up advance directives such as living wills and health care proxies or powers of attorney.

A Health Affairs study that examined a range of studies to determine how many people actually had gone through end-of-life planning reports that just 36.7 percent of subjects in the various studies “had completed an advance directive, including 29.3 percent with living wills … Similar proportions of patients with chronic illnesses (38.2 percent) and healthy adults (32.7 percent) had completed advance directives.”

Despite the difficulty of contemplating one’s own demise, a lack of end-of-life planning could be even scarier, whether one wants extraordinary measures taken to preserve life or simply to die peacefully at home.

In the report, Dr. Katherine Courtright, an instructor of medicine in pulmonary and critical care at the University of Pennsylvania and the study’s senior author, says, “Many people don’t sign advance directives because they worry they’re not going to get any care if they say they don’t want [cardiopulmonary resuscitation]. It becomes this very scary document that says, ‘Let me die.’”

In addition, making a living will won’t provide the proper instructions if someone’s wishes change over time. Dr. Diane Meier, a geriatrician and the director of the New York-based Center to Advance Palliative Care, says, “In some ways, the public’s lack of excitement about this is related to the reality that it’s very hard to make decisions about the kind of care you want in the future when you don’t know what that will be like.”

Such documents can be changed to reflect updated wishes, such as being willing to be put on a respirator for a few days to recover from pneumonia, as opposed to ending one’s life on a respirator with no prospect of healing in sight. And many people may be afraid to opt out of a respirator lest they get a case of pneumonia but have a living will that directs hospital staff not to use a respirator.

That’s when a health care proxy comes in, with someone designated to make such knotty decisions in the stead of the person in need (or not) of care. Hospital staff will not make the decision — but then there needs to be a conversation with the person standing proxy so that the patient’s wishes are known and can be carried out. That can be another tough conversation to have.

While the study finds that people older than 65 (45.6 percent) were significantly more likely to complete any type of advance directive than younger ones (31.6 percent), the difference between people who were healthy (32.7 percent) and those who were sick (38.2 percent) was much smaller. And though in the case of illness, there still may be time to put an advance directive in place, an accident can rob someone of any chance of expressing their wishes. In fact, Medicare began reimbursing physicians in January 2016 for counseling beneficiaries about advance-care planning.

Instant Insights /

End-of-life planning at bottom of Americans&rsquo; to-do list

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End-of-life planning at bottom of Americans’ to-do list