Exploring Ethnoracial Disparities in Planning for End-of-Life Care

Over the last 35 years, high profile court cases have drawn attention to planning for end-of-life care. Despite strong opinions about life-sustaining medical treatment, expressed through public protests and political debates, the majority of Americans do not have advance directives, which state preferences for end-of-life care. Rates are significantly lower for blacks and Hispanics than for non-Hispanic whites; however, the reasons for these disparities remain unclear. Using data from the 2012 and 2014 waves of the Health and Retirement Study (HRS), I examine ethnoracial differences in completing three types of advance care planning: (1) having discussions about life-sustaining treatment preferences; (2) designating a proxy—legally called a durable power of attorney for health care (DPAHC)—to make end-of-life care decisions on one’s behalf; and (3) writing a living will that states treatment preferences. Specifically, I conduct an exploratory descriptive analysis, estimate logistic regression models, and apply Fairlie’s decomposition technique—an extension of the Blinder-Oaxaca decomposition method for nonlinear models—to investigate the likelihood of planning for end-of-life care and to quantify the reasons for ethnoracial differences in advance care planning among non-Hispanic black, non-Hispanic white, and Hispanic adults age 65 and older. Findings suggest that education, wealth, income, and having a last will and testament predict the likelihood of and account for most of the explained ethnoracial gap in advance care planning. This study helps to improve our understanding of population characteristics that influence advance care planning. Additionally, while research generally presumes that advance care planning is beneficial, this study also discusses the potential flaws with this view.

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