Special Health Reports

Advance Care Planning


Advance Care Planning

Living wills and health care proxies — documents known as advance care directives — give you a voice in decisions about your medical care at the end of life. Without these documents, choices may be left up to a doctor or a judge — someone who does not know your values, beliefs, or preferences. This Special Health Report, Advance Care Planning: A guide to advance directives, living wills, and other strategies for communicating health care preferences, will help you plan ahead and create legal documents to guide decision makers at this important time.

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Many people shy away from preparing a living will or health care power of attorney, perhaps because it’s difficult to ponder death, or they aren’t sure what their end-of-life wishes are, or don’t know how to go about doing it. But taking some time to think about what kinds of medical treatment you would or wouldn’t want if you were unable to speak for yourself is can be a blessing for your loved ones.

Living wills and health care proxies — documents known as advance care directives — give you a voice in decisions about your medical care. Yet only a quarter or less of Americans have filled out advance directives. Without these documents, choices may be left up to a doctor or someone appointed by a judge — a person who may not know your values, beliefs, or preferences (your health care philosophy). Not only is it possible that the care you receive isn’t in keeping with your wishes, but this also may be a great burden on a loved one, who is forced to make difficult decisions without knowing what you would want.

So take the time to learn about and complete the necessary forms — the sooner the better. This report walks you through the process, explains the medical terms and procedures you’ll need to know, helps you determine what kind of end-of-life care you would want, and even provides the forms you’ll need.

Prepared by the editors of Harvard Health Publishing in consultation with Rachelle E. Bernacki, MD, MS, Associate Professor of Medicine, Harvard Medical School and David M. Godfrey, JD, Director of the American Bar Association Commission on Law and Aging. 49 pages. (2023)

What is a health care power of attorney?
A health care power of attorney is a legal document that permits you (the principal) to name a health care agent (sometimes called a health care proxy) who has legal authority to make medical decisions on your behalf if you are unable to make them yourself.

All adults should designate a health care agent. If you haven’t chosen anyone, a relative or court appointed guardian may be asked to make medical decisions for you. That person might not know your wishes or might not be comfortable following them. And if more than one close relative is at your bedside, the doctor may want all of them to come to a consen sus before following any of their instructions. Sometimes conflicts ensue, and decisions may be delayed. For example, let’s say your three adult children are there with you. Your doctor will probably want them all to agree before proceeding. But getting everyone to agree might be hard in such a stressful situation. It’s best if you’ve already appointed one person to handle medical decisions using your wishes as a guide.

Generally, both law and medical ethics dictate that your health care agent must make decisions that he or she thinks you would have made. This means that your agent must be very familiar with your values, goals, and priorities regarding your medical treatment. That requires honest conversations (see “Talking to your health care agent,” page 18), a written explanation of your wishes, or both.

Not completely certain about what you want? That’s okay. Reading the information in this report will help. The next chapter explains treatment options and key concepts (see “Step 1: Deciding on your wishes for care,” page 8). We’ve also created an informal docu ment called a health decisions worksheet (see page 30) that can help you make choices and communicate yourdecisions. Additional resources include online tools, smartphone apps, and even a card game designed to take you through the decision-making process (see “Online tools,” page 11). Note that your worksheet or online record is not legally binding, but it may provide more meaningful and flexible guidance than a formal, standardized living will.

  • What is advance care planning?
    • What are advance directives?
    • Which advance directives do you need?
  • Step One: Deciding on your wishes for care
    • Understanding your health status
    • Prioritizing your goals for care
    • Talking to your doctor about treatment options
    • Understanding key medical procedures and programs
    • Medical terms to know
  • Step Two: Choosing a health care agent
    • The basics
    • Talking to your health care agent
    • Privacy rules and health care agents
  • Step Three: Creating your advance directives
    • What are your goals for care?
    • Who needs to have your advance directives?
    • State-specific considerations
    • Religion-specific considerations
    • Changing your advance care plan
  • Pitfalls, fixes, and tips for tough conversations
  • The forms
    • Health decisions worksheet
    • Form 1: Health care power of attorney
    • Form 3: Generic living will
    • Form 4: Sample POLST form
  • Resources
  • Glossary


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