Category: Aging Well
Understanding Advance Care Planning & Medical Wishes
Advance care planning helps make sure your voice remains part of your medical care if an illness or injury prevents you from speaking for yourself.
It involves thinking about the care you would want, choosing someone who can make decisions for you, discussing your values, and documenting important preferences.
This is not only planning for the end of life.
A serious accident, stroke, infection, surgery complication, or temporary loss of consciousness can leave someone unable to communicate at any age. Advance care planning gives healthcare providers and the people you trust guidance during those situations.
You do not need to make every possible medical decision in advance. The goal is to provide enough information for others to make decisions that reflect your values and preferences.
Advance Care Planning Is a Process
Advance care planning is broader than completing a form.
It may include:
- Learning about possible medical treatments.
- Thinking about what makes life meaningful to you.
- Identifying situations you would find unacceptable.
- Choosing a healthcare proxy.
- Talking with family and healthcare providers.
- Completing an advance directive.
- Reviewing your preferences after health changes.
- Making sure the documents can be found.
Your wishes may change as your health, experiences, beliefs, or family circumstances change. Advance care planning should be revisited over time.
Begin With What Matters to You
Medical forms often ask about specific treatments, but those decisions are easier to understand when they are connected to your values.
Consider:
- What makes life meaningful to me?
- Which abilities are especially important to me?
- How much independence do I need to experience an acceptable quality of life?
- How do I feel about living with severe pain?
- How do I feel about being unable to recognize or communicate with people?
- Would I accept intensive treatment if recovery were likely?
- Would my answer change if recovery were very unlikely?
- Would I want treatment focused mainly on comfort?
- Where would I prefer to receive care?
- Are there religious, spiritual, or cultural beliefs that should guide my care?
- What worries me most about serious illness?
You do not need perfectly defined answers.
Statements such as “I would accept difficult treatment if there were a reasonable chance of recovering enough to communicate with my family” may give your decision-maker more useful guidance than a checklist without context.
Understand Advance Directives
An advance directive is a legal document that provides instructions for future healthcare or names someone to make decisions if you cannot communicate your own wishes.
The two most common forms are:
- A living will.
- A durable power of attorney for healthcare.
Some states combine these into one document.
Requirements, terminology, witness rules, and notarization rules vary by state. Use forms that are valid where you live and follow their instructions carefully.
The National Institute on Aging provides an overview of advance directives and advance care planning.
What a Living Will Does
A living will records your preferences about medical treatment if you cannot make or communicate decisions.
It may address:
- Cardiopulmonary resuscitation.
- Mechanical ventilation.
- Artificial nutrition.
- Artificial hydration.
- Dialysis.
- Antibiotics.
- Surgery.
- Blood transfusions.
- Pain management.
- Comfort-focused care.
- Organ and tissue donation.
A living will may allow you to explain which treatments you would want under different circumstances.
For example, your preferences may depend on whether:
- The condition is temporary.
- Recovery is reasonably expected.
- Brain injury is severe and permanent.
- You are in the final stage of an illness.
- Treatment would extend life without improving awareness or comfort.
Avoid relying only on broad statements such as “no extraordinary measures.” Different people may interpret that phrase differently.
Ask a healthcare professional to explain unfamiliar treatments and what they may accomplish in different medical situations.
What a Healthcare Proxy Does
A healthcare proxy is a person authorized to make healthcare decisions if you cannot make or communicate those decisions yourself.
The person may also be called:
- Healthcare agent.
- Medical decision-maker.
- Healthcare representative.
- Surrogate.
- Durable power of attorney for healthcare.
You continue making your own decisions for as long as you are able. Naming a proxy does not give that person immediate control over your medical care.
A proxy may need to:
- Speak with doctors.
- Review medical information.
- Compare treatment options.
- Consent to or refuse treatment.
- Select a facility.
- Interpret your advance directive.
- Make decisions that were not specifically anticipated.
- Explain your wishes to relatives.
Choose someone who can carry out your preferences even when the decision is difficult.
Choose Your Proxy Carefully
A good healthcare proxy should:
- Understand your values.
- Be willing to discuss serious medical situations.
- Ask healthcare providers questions.
- Remain calm under pressure.
- Communicate clearly.
- Handle disagreement.
- Be available when needed.
- Follow your wishes even if their personal choice would be different.
- Meet your state’s eligibility requirements.
Ask the person before naming them.
You may also name one or more backup proxies in case your first choice is unavailable.
Being the closest relative does not automatically make someone the best choice. Select the person most capable of representing your wishes.
Talk With Your Healthcare Proxy
A completed form cannot predict every medical situation.
Your proxy needs to understand how you think, not simply where the document is stored.
Discuss:
- What gives your life meaning.
- Conditions you would consider unacceptable.
- How you balance length of life with comfort or independence.
- Your willingness to undergo burdensome treatment.
- Your feelings about life-support treatments.
- Where you would prefer to receive care.
- Your religious or cultural beliefs.
- Who you want involved in discussions.
- How much medical information may be shared with others.
You can begin with a simple statement:
“If I could not speak for myself, I would want you to understand what matters most to me and help the doctors make decisions that reflect it.”
The National Institute on Aging offers a worksheet for choosing and preparing a healthcare proxy.
Understand CPR
Cardiopulmonary resuscitation, or CPR, may be attempted when someone’s heart stops beating or breathing stops.
It may involve:
- Forceful chest compressions.
- Electrical shocks.
- Medications.
- A breathing tube.
- Mechanical ventilation.
- Intensive hospital care.
The likelihood of successful recovery depends on the person’s health, the cause of the cardiac arrest, where it occurs, and how quickly treatment begins.
Ask your healthcare provider:
- How likely CPR is to restart my heart.
- What recovery might realistically look like.
- Whether CPR could worsen existing injuries or illness.
- What might happen after successful resuscitation.
- Whether my preferences should be documented as a medical order.
Your decision may differ depending on your current health.
Understand DNR Orders
A do-not-resuscitate order, commonly called a DNR, is a medical order instructing healthcare professionals not to perform CPR if breathing or heartbeat stops.
A DNR does not automatically mean:
- No medical care.
- No pain treatment.
- No antibiotics.
- No food or fluids.
- No treatment for reversible conditions.
- No hospital care.
- No comfort measures.
It addresses resuscitation unless additional medical orders state otherwise.
A preference written only in a living will may not function as an immediately actionable medical order during an emergency. If you do not want CPR, speak with your healthcare provider about the documentation recognized in your state and care setting.
MedlinePlus provides additional information about DNR medical orders.
Understand Portable Medical Orders
People with serious illness, advanced frailty, or significant health risks may be offered a portable medical-order form.
Depending on the state, it may be called:
- POLST.
- MOLST.
- MOST.
- POST.
- Medical orders for life-sustaining treatment.
These forms are completed with an authorized healthcare professional and translate current treatment preferences into medical orders.
They may address:
- CPR.
- Hospital transfer.
- Intensive treatment.
- Mechanical ventilation.
- Artificial nutrition.
- Comfort-focused treatment.
These orders are not generally intended for every healthy adult. Advance directives are broader planning documents, while portable medical orders are usually used when specific treatment decisions are likely to be needed.
Ask your healthcare provider whether one is appropriate.
Discuss Artificial Nutrition and Hydration
Artificial nutrition and hydration may be provided through a feeding tube or intravenous line when someone cannot eat or drink normally.
The potential benefits and burdens depend on:
- The underlying condition.
- Whether the problem is temporary.
- The likelihood of recovery.
- The person’s comfort.
- The risks of infection or other complications.
- Whether the treatment will meet the person’s goals.
Do not assume that artificial nutrition always improves comfort or that declining it means all comfort care stops.
Ask how the treatment would affect your particular medical situation.
Understand Comfort-Focused Care
Choosing not to receive a particular life-prolonging treatment does not mean choosing no care.
Comfort-focused care may include:
- Pain relief.
- Treatment for shortness of breath.
- Anxiety management.
- Mouth and skin care.
- Positioning.
- Emotional support.
- Spiritual support.
- Support for family members.
- Treatment of distressing symptoms.
Palliative care may be provided alongside treatment intended to cure or manage an illness.
Hospice is a specific type of care generally intended for people approaching the end of life who meet eligibility requirements and choose care focused primarily on comfort.
Discuss these options with a healthcare professional rather than assuming they are all the same.
Include Your Healthcare Providers
Ask your doctor or another qualified healthcare professional to review your wishes.
Useful questions include:
- What medical decisions are most likely given my health?
- What treatments should I learn more about?
- How would my current conditions affect recovery?
- Which forms are recognized in my state?
- Should any preferences become medical orders?
- Can my advance directive be added to my medical record?
- When should we review the plan again?
Advance care planning may be discussed during certain medical visits. Ask the provider and insurance plan whether there may be a charge.
Share the Plan
Give copies of completed documents to:
- Your healthcare proxy.
- Backup proxy.
- Primary-care provider.
- Relevant specialists.
- Hospital or health system.
- Attorney.
- Trusted family members when appropriate.
- Assisted living or long-term care community, if applicable.
Keep a copy somewhere secure but easy to access.
Do not store the only copy in a safe-deposit box or another location that may be inaccessible during a medical emergency.
Some states maintain advance-directive registries. Ask whether one is available where you live.
Review and Update Your Wishes
Review the plan after:
- A major diagnosis.
- Hospitalization.
- Significant change in health.
- Change in your values or treatment preferences.
- Death or illness of your healthcare proxy.
- Marriage or divorce.
- Move to another state.
- Move into a care community.
You may also review it every few years even when nothing significant has changed.
If you update or revoke a document:
- Follow your state’s requirements.
- Tell your healthcare proxy.
- Notify healthcare providers.
- Replace copies in medical records.
- Remove outdated copies.
- Make sure family members understand the change.
Helpful Resources: Browse Health & Caregiving Information for products, equipment, services, or supplies related to this section.
Start With a Conversation
You do not need to complete every form today.
Begin by:
- Thinking about what matters most.
- Choosing someone you trust.
- Talking with that person.
- Asking your healthcare provider questions.
- Completing the appropriate state forms.
- Sharing and reviewing the plan.
Advance care planning does not take medical decisions away from you.
It helps preserve your voice when you cannot speak for yourself.
