| I explore the ways in which family relationships, especially the marital relationship, affect end-of-life medical care preferences. This topic has been overlooked by previous researchers but is of critical importance to laypersons and health care providers. The participants in my study---healthy white adults in their mid 60s---considered their own needs and their families' needs as they formulated plans for end-of-life.;First, I examine married couples who discussed one spouse's preferences for end-of-life medical care. In emotionally close marriages, spouses felt that their wishes were understood. Those who felt understood, rather than misinterpreted, were likely to appoint their partner as their durable power of attorney for health care (DPAHC). Thus, effective communication, which typically occurs in strong relationships, is associated with legal planning for end-of-life care.;Second, I study married persons' preferences to either have their spousal surrogate follow their end-of-life care preferences strictly or to do as the spouse thought best at the time. Interestingly, those in close marriages wanted their preferences followed strictly. Because concern about burdening others with one's care was also positively associated with wanting preferences followed strictly, I conclude that happily married persons usually prefer to make their care wishes plain.;Third, I analyze participants' level of concern about burdening others at end-of-life. Neither marital nor parental status, nor the quality of one's marriage, was associated with concern about burden. People were highly concerned about burden if they perceived that there was no one they could ask for care. These findings imply that older white adults see burdening others, regardless of relationship or relationship quality, as undesirable.;Taken together, these findings suggest that older persons believe that their personal desire to maintain independence complements family members' need to maintain well-being. They make end-of-life decisions accordingly, choosing the options that, in their view, allow them the most freedom while protecting family members from burden. I use these insights to discuss the place of my study within the life course paradigm, suggest a program of future research, and propose ideas for developing health care policy and practice. |
