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Adults have the right to accept or refuse medical treatments. However, during serious illnesses, people are often unconscious or too sick to communicate their wishes. Advance care planning helps ensure that our values and wishes for health care are known, so they can guide our care during serious illness. It should be a part of routine health care.

What is advance care planning?

Advance care planning is the process of preparing for the possibility of being unable to make your own decisions about health care, usually because of serious illness. If you should become ill and unable to make your own decisions, this planning can help family members and health care providers decide what the goals of your care should be. These goals may direct treatments towards life prolongation in the event of temporary illness; or comfort and palliation of symptoms should you have a terminal illness or one that severely impairs your quality of life. In some circumstances, some types of treatments may be considered if there is hope that you will return to the type of life you would find fulfilling. Thoughtful discussions about what you value most in life and under what circumstances, if any, that life would not be worth living for you, can provide guidance to health care professionals and your family for your medical treatment and goals of your care.

How does one start the process of advance care planning?

First, think about your values and the things that are important to the quality of your life. What types of medical care would you want if you suddenly became ill? What would your wishes be if you were expected to be ill and unable to communicate indefinitely?

Then, talk to those close to you about your wishes. Events like a death of someone close to you, current world events and media programs may provide starting points for important conversations with your family and health care providers.

Your health care providers may also encourage and guide your advance care planning. Because they will be responsible for actual medical orders, discussing your wishes with them will help them pursue the treatments that best meet your goals for care.

Discussions may cover such issues as your wishes for health care treatments like cardiopulmonary resuscitation (CPR or chest compressions, electric shocks, and artificial breathing to bring back a person who has died), mechanical ventilation (being placed on a breathing machine) and artificial nutrition and fluids.

Finally, when you have made decisions about future care and have selected the best person to be your health care agent, you should complete your state's advance directives documents. Advance directive forms are based on state law in the state in which you live. For more information about advance directives and how to get copies of your state's forms, see below. Share copies with your health care providers and health care agent.

What are advance directives?

Advance directives are the written statements someone makes to instruct others about his or her future wishes for medical care decisions. There are two basic types of advance directives:

• those that have to do with instructions for medical care
• those that name the person who should make decisions for the patient at times when he or she cannot speak for himself or herself

Living wills and medical power of attorney papers are both examples of legal documents that are advance directives. Regulations for advance directives vary from state to state, but they often can be written up without a lawyer.

How should I choose a health care agent/proxy?

Your health care agent should know you and your values. You should be able to rest assured that, should your health care agent be called upon, he or she will be both willing and able to make health care decisions that will honor your wishes. The best proxy decision maker is not always a family member or significant other. Consider asking your agent to accompany you on visits to your health care providers, so he or she can understand your health care wishes and meet your providers.

What is a living will?

A living will is a written statement of instructions for future medical treatments in the event that you cannot speak for yourself.

What is a medical power of attorney?

A medical power of attorney is a legal document that allows you to name a person to make future medical decisions if you are unable to make decisions for yourself. This type of advance directive may also be called a "health care proxy" or a "durable power of attorney for health care." This person or "health care agent" can make health care decisions for you when you are too sick to make them for yourself.

When should I begin advance care planning?

The key is to plan early, in case you unexpectedly become unable to speak for yourself. Advance care planning is practical for all adults, not just those nearing the end of life.

How can I get an advance directive form?

Many different health care organizations and institutions provide the forms and assistance completing them free of charge. Check with your health care provider.

Where do I go for more information?

The Foundation for Health in Aging
Eldercare at Home
Chapter 27, "Advance Directives"
www.healthinaging.org/eldercare/chap27.html
(212) 755-6810

American Medical Association
www.ama-assn.org/public/booklets/livgwill.htm

Legal Services for the Elderly
www.aoa.dhhs.gov/aoa/dir/118.html
(212) 391-0120

Partnership for Caring
www.partnershipforcaring.org
(800) 989-9455

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