Advance care planning

Advance care planning is the process of thinking about and communicating your healthcare preferences in case you are unable to speak for yourself due to illness or injury. It is not only for older adults—people of any age can face a medical crisis that affects their ability to make decisions.

Advance care planning involves understanding the types of medical decisions that may need to be made, reflecting on your values, and making your wishes known to family, friends, and healthcare providers. These preferences are typically documented in an advance directive, a legal form that outlines your treatment preferences and/or names a person to make healthcare decisions on your behalf.

Common Advance Care Decisions

Advance care planning often includes decisions about life-sustaining treatments. These may include:

• Cardiopulmonary resuscitation (CPR): Emergency procedure to restart the heart and breathing.
• Ventilator use: A machine to help with breathing via a tube in the airway.
• Artificial nutrition and hydration: Feeding tubes and IV fluids.
• Comfort care: Focused on relieving suffering and improving quality of life.

Getting Started with Advance Care Planning

You can begin by talking to your doctor about your health conditions and how they might affect you in the future. Discussing scenarios such as stroke, coma, or terminal illness can help you decide what treatments you would or would not want.

Consider your values:

• What makes life meaningful to you?
• Would you prioritize longevity or quality of life?
• How do you feel about living with severe disabilities or in a coma?

Expressing Your Medical Wishes

There are several ways to formally express your healthcare preferences:

• Living will: Specifies which life-sustaining treatments you do or do not want.
• Durable power of attorney for health care: Appoints a healthcare proxy to make decisions for you.
• Other documents: May include preferences on blood transfusions, kidney dialysis, or organ donation.

Legal Tools: Advance Directives, Proxies, and DNR Orders

An advance directive typically includes:

• A living will
• A durable power of attorney for healthcare

You may also use:

• Do not resuscitate (DNR) order: Prevents the use of CPR.
• Do not intubate (DNI) order: Declines use of a ventilator.
• Organ donation documentation: Expresses your wishes to donate organs.
• POLST or MOLST forms: Physician or medical orders for life-sustaining treatment, especially useful for people near the end of life.

Choosing a Healthcare Proxy

When selecting a healthcare proxy:

• Choose someone you trust and who understands your values.
• Discuss your wishes in detail with them.
• Name an alternate proxy in case your primary is unavailable.
• Define the level of authority your proxy has over your medical decisions.

Making Your Healthcare Directives Official

To formalize your advance directive:

• Use your state’s specific forms, which may be available through your local Area Agency on Aging.
• Some forms may need to be signed, witnessed, or notarized.
• Store your directive in a place accessible to family and healthcare providers.
• Consider state registries for quick access by medical personnel.

Next Steps After Setting Up an Advance Directive

• Share copies with your proxy, doctor, and loved ones.
• Include in hospital records if admitted.
• Review and update periodically or after major life changes such as:
  • Diagnosis of a serious illness
  • Marriage, divorce, or death of a loved one
  • Change in your proxy’s availability or willingness

Be Prepared

If you have no advance directive and become incapacitated, your state may assign someone (usually a close family member) to make decisions. Without a designated proxy or written instructions, decisions may not reflect your preferences.

An advance directive is only used when you are unable to make decisions and require emergency care or life-sustaining treatment. Preparing now can bring peace of mind to you and your loved ones.

See Also

• Palliative care
• Hospice care
• Health law
• Medical ethics
• End-of-life care
• Aging and health