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Advance Care Planning: A Guide for Future Health Care Decisions



Life can be unpredictable. An accident or sudden change in our health can happen at any time.

Advance care planning is the process of documenting your preferences for future medical care to ensure that your wishes are consistent with the care you might receive if you cannot speak for yourself or make your own decisions.

While many of us do not like to think that we will ever need such an advance health care plan, too often the lack of future care planning can result in confusion and even disagreement among family members trying to determine your wishes.

The best time to consider how you want to receive future medical care is when you are healthy. Planning with a clear state of mind allows you to begin conversations early so your loved ones and health care providers become familiar with your values and wishes over time.

Planning My Way is a comprehensive resource guide that helps you create and personalize your advance care plan.

Only one person is truly qualified to tell your health care providers how you feel about different issues, and that’s you. Planning My Way will help facilitate an open conversation so that your wishes are clearly understood. Find out more from our Advance Future Care Planning Process Guide below.

Stage I: Thinking About What You Want

Thinking about future medical decisions is never easy, especially when it involves the possibility that someone else could be making those decisions on your behalf.

Every person is unique. Two people with the same condition can have very different ideas about what kind of treatment they want.

Have you considered what kind of medical care you would choose if you couldn’t tell your providers what you wanted? What are your thoughts on the use of life-sustaining treatments such as a ventilator or feeding tube? Do you have any religious beliefs that might influence your wishes? Who should (or shouldn’t) be contacted in an emergency?

There’s no right or wrong answer to any of these questions, but thinking about your wishes now can provide peace of mind later.

Planning My Way offers guide sheets for Who to Contact in an Emergency, Treatment Decisions, and End of Life Arrangements to help you consider the things that are important to you.

Stage II: Choosing A Spokesperson

Choosing a spokesperson (legally called a “Health Care Proxy” or “Surrogate”) is an essential step in future elderly care planning. Your spokesperson will speak and act on your behalf in the event you are unable to do so.

Without a designated spokesperson, one will be appointed for you – usually next of kin. Depending on your situation, the person appointed to act as your spokesperson may not know your wishes or share your views.

There are many factors to consider when selecting a spokesperson, and it’s important to get it right. Planning My Way’s Choosing a Spokesperson guide sheet can help you determine the person that is best suited to speak on your behalf.

Once you have identified the person best suited to be your spokesperson, talk with them to make sure they understand the role’s responsibilities and have no doubts. Explain what you are asking of them and why you picked them.

If they agree to be your spokesperson, discuss your wishes by sharing your Who to Contact in an Emergency, Treatment Decisions, and End of Life Arrangements guide sheets. It’s impossible to predict every conceivable scenario, but these guide sheets can help your spokesperson understand what matters most to you.

A Durable Power of Attorney for Health Care document tells your health care providers whom you want to make medical decisions for you if you get too sick to decide for yourself. It is included in most advance directive forms.

Stage III: Talking About What You Want

Talking about what you want can be the most challenging step in the advance elderly care planning process. It’s important to remember that you are giving your loved ones a tremendous blessing. By sharing your wishes, you are empowering them to do what is best for you while honoring your values and dignity.

The most important person to talk to is your spokesperson, but you should also speak about your wishes clearly with your loved ones and health care provider.

Remember, there is no “right” time or way to start a dialogue about your advance care plan. Just set a time and see how far you get. Many people revisit this conversation in stages. Planning My Way’s What to Talk About guide sheet can help you navigate the conversation.

Stage IV: Documenting What You Want

Even if you have completed legal documents, your loved ones may still feel uncomfortable or unsure about making correct decisions on your behalf. When faced with such complicated decisions, a letter – or even a video – from you, in your own words, can sometimes be the most important thing of all.

A personal statement reassures your loved ones that they are doing the right thing within the framework and guidelines you have provided. Planning My Way offers a guide sheet to help you write a personal statement.

After you finish writing your personal statement, you are ready to complete your advance directive.

It’s important to note that the laws governing advance directives vary from state to state, so you must complete and sign advance directives that comply with your state’s law. You can download your state-specific advance directive from the National Hospice and Palliative Care Organization (NHPCO) website. Read the instructions carefully to make sure that you have included all the necessary information and that your documents are witnessed properly.

Advance directives do not expire, and they remain in effect unless you change them. You should review your advance directives periodically to ensure that they still reflect your wishes.

After completing your advance directive, give copies to everyone who might be involved with your health care, such as your physician, spokesperson, family members, and close friends. Your personal statement can be attached to your formal advance directive and other Planning My Way guide sheets.

About Planning My Way:

Planning My Way is a project of the Cunniff-Dixon Foundation in collaboration with Robert Pearlman, MD, MPH, of the University of Washington, and Melissa Bottrell, MPH, Ph.D. of Ethics Quality Consulting. The vision, research, and testing of Planning My Way originated with Dr. Pearlman and colleagues several years ago involving Veterans and their family members and received broad review from a diverse panel of end-of-life and ethics experts, including clinicians, clergy, and consumer advocates. The partnership helped bring that work forward to a consumer-oriented print and digital workbook experience that helps individuals and families think about, learn, and communicate what matters to them as they contemplate both legal and supporting future health care directives. The Cunniff-Dixon Foundation’s mission is to enrich the Doctor-Patient relationship near the end of life by fostering human development in medicine and supporting and funding projects relating to Palliative Care.

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