Table 4.

Barriers to doing ACP

Theme	Representative Quotation
Too difficult to think about dying	I don't want to think about [the end of life]. You know, it's “I'm going to live forever” and so forth.
	It is just that [avoiding planning] goes with the feeling that you are going to go on forever.
	I just don't want to face anything.
Lack of knowledge	[A living will is] when you make a will up while you're living that says… I think it is more or less telling your family members that if something should happen to you, these are the things you would like done and specifically I guess more so with your body. Like some of your body parts if you want them to be willed to the hospital for research, and things like that.
Inability to plan for the future	How can you plan when you don't know what is going to happen?
Planning not necessary because family knows what to do	I haven't given this matter too much thought, but the kids are all doing wonderfully and so I kind of depend on them if I'm in a situation where I can't think for myself. I have no concern that somebody will make the right call.
Future in God's hands/suffering is necessary	I think it is in God's hands anyway because he sees what is best…. If God sees fit for me to suffer for some of my wrong deeds that I did and didn't know no better, then that is in the Lord's hands.
Physician will make decisions	Well, I think your doctor is educated enough to make a decision for you because he has the expertise and he has a lot of knowledge.
No medical choices to be made	At this stage of the game, I don't think they can do too much when you get sick. They can make you comfortable. That's about all you can do.
No one available to be surrogate decision-maker	I would have to make the decision myself because I have no one.
Putting things down in writing might result in treatment being withdrawn too soon	I just didn't want somebody saying, “Hey, Charlie, pull the plug, this guy has signed this thing.
Loved ones unable or unwilling to discuss ACP	I only have a daughter and … I couldn't talk to her anyway because she would fall apart.