Older Adults’ Preferences for Independent or Delegated End-of-Life Medical Decision Making

Abstract

This study assesses the proportions of participants who prefer independent or delegated medical decision making at the end of life and examines the relationships of personal beliefs, affiliative beliefs, and end-of-life planning behaviors to decision-making preference. Data are drawn from the Wisconsin Longitudinal Study, a sample of nearly 4,500 healthy White Midwestern high school graduates in their mid-60s. Four fifths of participants wanted to make decisions independently. Valuing independence, being less avoidant of thoughts of death, and valuing quality of life over length of life had strong associations with a preference for independent decision making. Those concerned about burdening a caregiver wanted to make independent decisions. Persons who both executed a living will and appointed a durable power of attorney for health care preferred independent decision making. Older adults cite personal and affiliative beliefs, not lack of autonomy, as reasons for their choice to decide independently or delegate.