Advance care planning
You might hear “advance care planning” and think, “I’m not quite ready for that, am I?” But the truth is, advance care planning is simply that. It’s planning, in advance, how to handle certain health care decisions on your behalf that may come up in the future. It should be a natural conversation with loved ones about what’s important to you. You’ll express your preferences and wants as they relate to your health, should you ever become unable to make those decisions for yourself. It’s a way for loved ones to know what to do and how to support your wishes.
What is advance care planning?
The outcome of advance care planning is a legal document known as an advance directive. It’s only used if you’re unable to make your own health care decisions. Creating that document includes conversations around things like:1
- The types of available life-sustaining treatments (things like intubation, ventilation, artificial nutrition, etc.)
- Your decisions about what types of treatment you would or would not want if you’re diagnosed with a life-limiting illness
- Who you choose to speak on your behalf
Advance care planning is just like anything else you’d do to prepare for an unpredictable event. Think of it like an emergency plan you might have at home in case a storm happens. Your oldest child might be in charge of bringing the dogs inside, another child might be in charge of getting sentimental items to protect, and your spouse might be in charge of getting everyone to a safe room. Each person has a clear job and the whole situation becomes less confusing and stressful. When dealing with an illness, having a plan in place (just like that emergency plan) makes everything a little easier – and it helps provide peace of mind for everyone involved.
You might be wondering if you need an advance care directive. The answer is no, but it may help make life easier for your family and friends because it can help reduce stress and confusion during a difficult time. It especially helps those who might be caring for you during an illness. Without an advance care directive, you’ll still get medical treatment. However, health care providers will turn to the people closest to you when it’s time to make decisions about your health. So, if you don’t have your personal preferences communicated and documented, the decisions that are made might not be exactly what you would have wanted. Plus, it could be a lot harder on your family. 2
Before you make your advance health care directive, decide which one you want. You have 3 to choose from, or you could make them all. They each add their own value in making sure your wishes are met, and that your loved ones know what to do if they need to make decisions for you:3
- Living Will: A written document that specifies the types of medical treatment you want in certain situations (but doesn’t appoint a single person to be the decision maker). It can be as general or detailed as you’d like, and it may outline your preferences around the use of things like, pain relief, antibiotics, hydration, feeding and ventilators.
- Health Care Power of Attorney/Health Care Proxy: A legal document that assigns another person to make your health care decisions and communicate your wishes. This person has the right to request or refuse treatment on your behalf.
- Durable Power of Attorney: A legal document that names another person in charge of making financial decisions on your behalf if you’re unable to make them yourself.
The first step to advance care planning is having a conversation with your family and friends about what’s important to you. (And if there's some disagreement, rest assured, that’s normal.) This conversation is your chance to express your wishes and help loved ones understand them. This can include lots of different topics outside health care, like legal, financial and any end-of-life decisions.
Next, consider creating your legal documents (living will, health care proxy, power of attorney). Depending where you live, you may need to have your forms notarized. Keep these documents in a single, safe place. You may also want to make copies for loved ones or your doctors. If anything changes, make sure your documents are updated as needed.4
Finally, think about where you spend your time. If you split the year between two different states (hopefully one is warm), then you may want to create an advance care directive for both states to be safe. Oh, and keep copies of both states together, in each state.
What’s the Five Wishes® document?
The Five Wishes document is a popular tool to help you write your legal advance directive in a way that’s easy to understand. It captures all areas of life (health, personal, emotional, spiritual), and is a good document to help guide your conversations with loved ones around these topics. Your Five Wishes are:
- Who I want to make health care decisions for me
- The kind of medical treatment I want or don't want
- How comfortable I want to be
- How I want people to treat me
- What I want my loved ones to know
Five Wishes is written in plain language and is available in 23 different languages. It meets the legal requirements in 42 states. If it doesn’t meet legal requirements in your state, you still might want to consider using it as a guide to capture this important information. Then, you can transfer your wishes to the legal document your state requires.
You can seek the help of a lawyer, or not – it’s up to you. (Keep in mind, working with a lawyer will cost some money.) Since each state has different requirements, it’s important to find your local Area Agency on Aging to find out what they are. Or, you can call 1-800-677-1116 to talk to an Information Specialist. They’re available Monday – Friday, 9:00 a.m. – 8:00 p.m. ET.
Do I need to talk to my doctor about my advance care planning documents?
Another great question. It’s not necessary to talk to your doctor about your advance care planning, but it’s probably a good idea. You can never be too prepared. Your doctor can take a look at your documents and make sure your health care directive is clear and that there’s no concern with your wishes from a medical perspective. Your doctor can also help you clarify anything that needs a little extra detail. Plus, if you have questions about things you've read or heard about advance care directives, they could point you to good resources for answers.