Almost no one dies today without someone having to make a decision to limit, refuse or withdraw a life-extending/death-prolonging medical treatment whether due to an unexpected emergency or a long battle with a chronic illness.  Most often, these decisions fall to loved ones who are coping with a crisis and have no idea what choices the patient would want.

Advance directives come in tow main forms: either a healthcare power of attorney (or proxy, agent or surrogate) documents the person you select to be your voice for your healthcare decisions if you cannot speak for yourself OR a living will documents what kinds of medical treatments you would or would not want at the end of your life.

Advance Care Planning or ACP is a process that I’ve broken down into a series of steps below. When should you do it?  First, when you are healthy. Repeat when you experience a turning point, such as your named Power of Attorney for Healthcare is no longer available, you are diagnosed with a life-limiting disease, or chronic illness makes you vulnerable to a biological crisis such as stroke, cardiac arrest, or dialysis.

  1. Have “The Conversation” with loved ones and doctors who would be affected by your end-of-life experience and death. It is the most important thing you can do to protect yourself.  Documenting your wishes spares your loved ones from the guessing, conflict, and trauma such situations often produce, and reduces suffering for you and all involved by giving your healthcare providers clear directions for your desired treatment. The Conversation Project Starter Kits will help you. Consider having your Conversation over coffee like the Death Cafes are doing all around the world, or host a Death Over Dinner.
  2. If you’re over the age of 18, complete a Power of Attorney for Healthcare (POA) form that names one person you trust to speak for you in the event you cannot speak for yourself. If hospitalized and unable to speak for yourself—for any reason—the hospital will ask, “Who is the person with the papers?” The forms vary but often name one or two subordinates in case the person you chose becomes unable or unwilling to fulfill the role. Though you do not need an attorney, many attorneys include Advance Healthcare Directives in estate planning.
  3. Everyone over 18 should also complete legal Advance Healthcare Directive forms and share them with your doctors, and your POA for Healthcare, and any other surrogate decision makers who will speak for you if you become unable to represent yourself in the hospital. Note that advance directives do NOT go into effect until the person is unable to make decisions for themselves.

    Information and free legal Healthcare Directives forms for every state as well as instructions for holding a community event are available at the National Healthcare Decisions Day website

  4. Fill out a Living Will giving basic instructions for removing life support in critical cases, like Terri Schaivo’s. Basic living will forms offer three choices for when artificial life support treatments are the only way to be kept alive: do everything; if life support has been started, stop it; and I do not want life support.

    Other living wills go further. For $5 you can download the Five Wishes which I recommend, offering additional choices for personal care and communications to loved ones.

      Wish One:

    The Person I Want to Make Care Decisions For Me When I Can’t.

      Wish Two:

    The Kind of Medical Treatment I Want or Don’t Want. You should consult with your doctor before filling out this section relative to your medical condition(s), i.e. tube feeding, resuscitation, surgery, etc.

      Wish Three:

    How Comfortable I Want to Be. This Wish offers comfort choices including pain management, warm baths, oral care, music, religious readings, hospice care, etc.

      Wish Four:

    How I Want People to Treat Me. Do you want people with you near death, praying or not, pictures of loved ones near, die at home or not. You can cross off what you don’t want and write-in more.  I have added that I want chocolate ice cream not vanilla, my glasses or eye shades on my face, my chin hairs removed, socks on my feet, classical music played softly all the time, my body massaged with warm lotion, and admit me to hospice care as soon as possible.

      Wish Five:

    What I Want My Loved Ones to Know. I love you, thank you, I’m sorry and I forgive you are some of the twelve tender choices listed on this page.

  5. Should you enter long-term care or your medical condition is likely to lead to life-support decisions within the next 12 months, complete a POLST (Practitioner Orders for Life Sustaining Treatment) form for end-stage care. The form varies from state to state and offers choices for CPR, tube feeding and comfort care. It is a medical order, like a prescription, and can only be changed by the person you choose to speak for you, your POA for healthcare, or your legal guardian.

One day ACP will be part of our lifestyle the way it is for the people of LaCrosse, WI where the Respecting Choices ACP organization has been empowering patients and changing lives for 30 years.

There are extraordinary outcomes of confronting our mortality and engaging in ACP.  We become even closer to our loved ones, relieve ourselves of the worry about “what if?” and begin to accept the reality that we are mortal and discover what really matters in our lives.  These outcomes have proven to increase gratitude, happiness and peacefulness. I believe you will find that to be true, too.

Disclaimer: I am not a legal or medical professional.  I do not intend to give advice on either subject.  The information on this website is documented on legal and medical websites included here.