Advance care planning is a way of planning for the “what ifs” in life. Having a plan lets you make sure that the medical care you receive is what you want, if you are unable to speak or make decisions about your health care or treatment. It’s often associated with old or sick people, but advance care planning is important for healthy individuals of all ages. Sudden illness, or a serious accident or injury, can happen to anyone.

​

Who should consider advance care planning?

 

Few of us want to think about what would happen if we or a loved one were in a devastating accident or incapacitated by advanced illness, yet it’s recommended that everyone over the age of 18 have a plan. Advance directives let your family and your medical team know what your wishes and preferences are—and that they are honored.

​

A plan means your family doesn’t have to wonder if they did the right thing. It avoids confusion, arguments, or disagreements among family members trying to decide what to do if you cannot speak or make your wishes known. 

 

Having a formal plan in place and sharing it with your loved ones and your doctors can help relieve or prevent unnecessary suffering, improve quality of life, and help you and your loved ones better understand the decision-making challenges you face.

​

What does advance care planning include?

​

Advance care planning is a four-step process that helps you plan for future medical care in case you are ever unable to make your own medical decisions:

1. Think about your wishes and what person or people you would want to make health care decisions for you if you are unable to make them for yourself.

2. Have meaningful and focused talks with your family and doctors about your medical condition, treatment options, and goals.

3. Create written documents, called Advance Directives, that state your health care wishes.

4. Review your goals and documents regularly as your condition changes.

​

Questions to ask yourself, and to discuss with your family and your doctor:

​

• What tests, procedures, life-sustaining measures, treatments, or medications do you want?

• Which do you not want?

• What might happen for you to want to stop them? For example, some treatments may cause painful side effects. You may decide that it’s important to enhance or maintain your quality of life, even if your life is a few months or weeks shorter, than to extend your life through a series of medical interventions.

• What is your prognosis for recovery?

• What is important to you? Will a procedure allow you to continue an activity or meet a goal, or is it likely to compromise your recovery?

• Where do you want to receive care? (You may want to avoid hospitals when your illness reaches a certain stage.)

• Who do you want to speak or make decisions on your behalf?

​

Discussing with Your Doctor

​

Medicare now covers advance care planning conversations between doctors and patients and their caregivers. When you make an appointment, let the staff know you wish to discuss advance care planning. These appointments may be longer than other office visits, so the staff may want to block out more time so you and your doctor are not rushed.

Choosing a Health Care Agent

An important element of creating a plan is naming a health care agent. Your health care agent is the person you designate to make decisions about your care if you are unable to do so. Your agent should be:

• Someone you trust, like a family member or close friend

• Someone you have discussed your health care wishes with

• Someone who has agreed to be your health care agent

• Named in writing on your health care proxy form

When should I consider advance care planning?

 

Advance care planning can be done at any point in your life. It is especially important if you do not want aggressive treatment or feel strongly about avoiding life-saving or life-sustaining measures. Our culture, and our medical culture, are oriented toward saving lives, without necessarily considering quality of life.

​

As a person’s condition changes, their treatment and goals for treatment should also change. You may want to review your advance directives periodically to make sure they still reflect your wishes. Advance care planning is especially important if you have a disability or a chronic or progressive illness.

​

Over the course of a disease, most people enjoy periods where they have a good “quality of life”—they are able to take part in activities they enjoy and do things that are important to them. But most chronic diseases eventually result in a period of declining health or disability. Some diseases make it difficult to speak or think coherently, and sometimes people don’t want to disappoint their loved ones by appearing to “give up.” It is often easier to make decisions when they are hypothetical.