> ## Content Index > Fetch the complete content index at: https://www.foodconsumer.org/llms.txt > Use this file to discover other available public pages before exploring further. # Who Makes End of LIfe Decisions for Homeless? - URL: https://www.foodconsumer.org/who_makes_end-of-life_choices_for_homeless_072820100949/ - Published: 2010-07-28T10:42:00.000Z - Updated: 2026-09-20T15:49:42.000Z - Description: Homeless people are especially unlikely to have an advance directive and often lack family nearby to help with decisions at the end of life. John Song and colleagues at the University of Minnesota ran a randomized trial comparing self-guided completion of an advance directive with assisted planning. - Author: Rachel Stockton - Tags: Lifestyle, Health News, #vivvo-import Who is Making End-of-Life Treatment Decisions for the Homeless? Sometimes, in spite of treatment, a condition or illness will cause death. In those cases, patients can decide what they do and do not want done. They can decide whether they want aggressive treatment that might prolong life or whether they prefer to stop treatment, which could mean dying sooner but more comfortably. They may want to die at home, in a hospital or a hospice. They may want to plan their own funeral. Everyone has the right to decide what types of medical care to receive. An advance directive is a legal document that lets people choose what medical treatment to receive in different situations, as well as make the patient's wishes clear to families and health care providers. This is especially important if, at some point, a person is unable to tell their health care providers their wishes because of serious illness or injury. Most Americans have not completed an advance directive, leaving sometimes difficult decisions up to grieving loved ones. In the case of homeless persons, who are especially unlikely to have an advanced directive and not likely to have family in close proximity to help with issues surrounding death, it is especially confusing and frightening. Few interventions have focused on improving end-of-life care for underserved populations, such as homeless persons. John Song, MD, MPH, MAT, Assistant Professor, Center for Bioethics; Assistant Professor, Department of Medicine, University of Minnesota Medical School and colleagues, conducted a prospective, single-blind, randomized trial comparing self-guided completion of an advance directive with professionally assisted advance care planning. The objective of the study was to determine whether homeless persons would complete a counseling session on advance care planning and follow through with filling out the legal advance directive designed to assess case preferences and preserve their dignity. The full report is titled “Effect of an End-of-Life Planning Intervention on the Completion of Advance Directives in Homeless Persons, A Randomized Trial” is in the July 2010 issue of Annals of Internal Medicine. Researchers enlisted 262 homeless persons from 8 sites serving homeless persons in Minneapolis, Minnesota. Homeless persons who showed that they could make decisions independently were enrolled in the study and randomly assigned to receive either intensive counselor-guided support in completing the advance directive or written information with help reading the advance directive when needed. The study team then counted how many persons returned an advance directive within 3 months that was complete enough to be legal. Researchers found that 37.9% of persons who received one-on-one counselor guidance completed an advance directive, while only 12.8% who received only the written educational assistance completed the form. This difference persisted across all 8 sites and most subgroups. In 4 examples of clinical situations, 29% to 34% of participants wanted someone else (such as family) to make decisions for them. The homeless persons in this study were from somewhat more stable living situations and, because they answered an advertisement, were probably more interested in filling out an advance directive than most homeless persons. If given personal counseling, about 1/3 of the homeless population will complete an advance directive and identify someone to make treatment decisions for them if necessary. The reading materials along with the advance directive form without some one-on-one intervention and counseling seems to be of little help due to the rarity of advance directives among the homeless. Homeless persons can respond to an intervention to plan for end-of-life care and can express specific preferences for care or a surrogate decision maker, but additional studies are needed to assess the effect of these directives on subsequent care. “We need more doctor-patient discussion in this area. As many as three-quarters of physicians whose patients had advance directives were unaware that those documents existed, according to research, and only 12% of patients with advance directives had received input from their doctor”, says Carolyn M. Clancy, M.D., Director, Agency for Healthcare Research and Quality (AHRQ), U. S. Department of Health and Human Services. Types of advance directives worth considering include: \*A living will, which is a formal legal document, authorized by State laws, that describes the kinds of medical treatments you want or do not want if you become incapacitated. It can be as specific or general as you wish. \*A durable power of attorney, also known as a health care proxy, is a document that lets you designate a person to make treatment decisions for you if you cannot make those decisions. \*A Do-Not-Resuscitate (DNR) order is a document that directs what measures should or should not be taken on your behalf in events such as cardiac or respiratory arrest. Typically, a DNR order is directed to emergency medical services or other first responders. Furthermore, says Clancy, “Talking about our concerns and taking steps to address them remains solid advice throughout life, even as we anticipate its end.” Laura Lamp King