The Possibility of Health Care Directives for Vaccinations-A Consultation Study With Relevant Stakeholders

Health care directives allow individuals to express their wishes about future health care treatments if they become unable to communicate their wishes (e.g., due to cognitive impairment). Because vaccinations have become contentious preventative treatments whereby future wishes might not be honored by others, vaccinations should be given specific consideration for potential inclusion in health care directives. The purpose of this project was to explore and receive preliminary feedback on: the idea of vaccination-specific directives; support for draft statements; and practical implications.

We conducted two discrete online surveys with individuals in professions engaging with health care directives (e.g., health care, long-term care, and legal), as well as advocates for older adults, in 2023 and 2024. In the first survey (n = 39), we canvassed initial reactions to the idea of vaccination-specific directives and requested feedback on draft statements. Using an iterative approach, we analyzed the first survey to craft the second survey (n = 151), to receive feedback on a revised directive statement, and to identify dominant themes.

Overall, there was broad support for the idea of vaccination-specific directives. In the first survey, 87.2% agreed that it made sense to them. In the second survey, 83.3% of respondents agreed that the proposed statement was clear, with 72.0% indicating "yes" that the statement would result in a person receiving vaccines. Dominant themes across both surveys included logistical challenges with directives; whether wishes would be honored; and the need for public and professional education.

Professionals and advocates for older persons indicated significant support for the development and use of vaccination-specific directives. Accordingly, persons who wish to be vaccinated should consider creating such a directive, as it may better advance their wishes and reduce family stress and conflict by providing clear direction in future circumstances-which could include encountering anti-vaccination sentiment.