1. Planning Ahead: Advance Directives and End-of-Life Decisions
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2. Planning Ahead: Advance Directives and End-of-Life Decisions
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3. Our Goals Discuss advance directives and end-of-life care decisions.
Learn the different types of advance directives.
Recognize advantages and disadvantages of advance directives.
Identify resources that can help you complete your advance directives.
Purpose of our discussion today is to:
Discuss advance directives and end-of-life care health care decisions
Learn the different types of advance directives
Recognize advantages and disadvantages of advance directives
Know resources that can help you complete your advance directives

4. Do You Have a Map?
…a written plan stating what health care treatments you would or would not want if you could not speak for yourself?
Advance care planning is like planning a road trip to an unfamiliar destination. While people approach mapping their route in different ways, your trip can be made more comfortable by planning ahead.
An advance directive is a map detailing where you want your health care ‘go’ in the future should you not be able to voice your wishes
Before we begin talking about the specifics of advance directives, do YOU have a written plan stating what kind of health care treatments you would want (or not want) if you could not speak for yourself?
This is basically what advance directives are.
If you do not have an advance directive, listen to one story that could change your mind about completing your documents.

5. Why is it Important? Victor’s story…
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Victor is a married business executive whose best friend was in a coma from a critical car accident. After his friend was in the intensive care unit for 4 weeks, he was diagnosed as “brain dead.” Victor witnessed the agonizing and difficult decisions his friend’s family had to make about whether to continue life-sustaining treatments or not.
Victor’s friend had never talked about his end-of-life care wishes and had not completed his advance directives which left his family in a major crisis about what decisions to make. Victor knew that if he were in the same situation, he would not want to be kept alive on a ventilator and feeding tubes. Victor talked to his wife about what he would want if he were ever in a similar situation and completed his advance directives. Victor also discussed his advance directives with his primary doctor and gave him a copy to include in his medical records.
Since Victor has talked about what health care he wants and does not want with his wife and doctor, he can now trust that his end-of-life care wishes will be honored.
Victor’s example is one of many that highlights the need for all of us to think through and make a plan about our care at the end of life.

6. Why You Need an Advance Directive
Your wishes will be known
Only used if you are unable to express your decisions
This can happen to anyone - at any age
Give your loved ones the gift of peace of mind – write down your wishes!
Why YOU need advance directives:
If you have a sudden accident or illness – your wishes will be known
As long as you are able to express your decisions your advance directives will not be used
You may lose the ability to participate in decisions about your own treatment
Give your loved ones the gift of peace of mind – write down your wishes!

7. Interesting to note…
Most Americans – 88 percent – feel comfortable discussing issues relating to death and dying.
Yet research has found that only 42% have a living will.

8. What are Advance Directives?
A written statement of your wishes, preferences and choices regarding end-of-life health care decisions.
A tool to help you think through and communicate your choices.
It is a road map for your future health care.
Advance Directives:
Are a written statement of your wishes, preferences and choices regarding end-of-life health care decisions
List your wishes, preferences and choices regarding end-of-life health care decisions in the event you can not speak for yourself
Are a tool to help you think through and communicate your choices
It is a road map for your future health care

9. Advance Directives
Written instructions about future medical care are only used:
If you are seriously ill or injured AND
Unable to speak for yourself
Two parts to an advance directive:
Living will
Medical (health care) power of attorney
Note: Each state regulates the use of advance directives differently.
Generally advance directives are:
Oral and written instructions about future medical care
Only used if you are seriously ill or injured AND unable to speak for yourself
Two documents that make up an advance directives:
Living will
Medical power of attorney – or deciding who will speak for you if you cannot speak for yourself?

10. Living Will A living will is one part of an advance directive.
A legal document with your wishes about medical treatment
You choose what you do want & don’t want
Think of it as a route on your map
It’s YOUR journey
Your right to accept or refuse treatment is protected by constitutional and common law through a living will.
A Living Will is a legal document with your wishes about medical treatment.
You can choose what treatments you want and do not want.
A living will, like a route marked on a map, indicates which direction you’d like to take at each fork in the road.
It’s your journey – and you decide which roads you want to take and when.

11. Medical Power of Attorney
A document that specifies who you want to make decisions about your medical care
The person is authorized to speak for you ONLY if you are unable to make your own medical decisions
May also be called:
"health care proxy or agent"
“health care surrogate”
"durable power of attorney for health care"
Medical Power of Attorney can be used at anytime - Not only at the end of life!
This is a legal form that states who you want to make decisions about medical care.
The person is authorized to speak for you any time ONLY if you are unable to make your own medical decisions.
In essence, this is your back up driver so that when unexpected road blocks appear along your health care journey, your back-up driver is able to choose a detour that is in keeping with your values, wishes and choices.
May also be called:
"health care proxy or agent"
“health care surrogate”
"durable power of attorney for health care“
Gives a much broader scope of decisions than the living will document.
Complete both parts of your advance directives to protect your wishes for care at the end of life, or simply name your medical power of attorney to ensure the right person will speak on your behalf.

12. Advance Directive: Advantages
You are in charge of making your own decisions
Documents can be changed anytime
You DO NOT need an attorney
Documents can help you express your wishes
Forms are available for FREE at
Advantages of advance directives are:
You are in charge of making your own decisions
Documents can be changed anytime
You DO NOT need an attorney
Documents can help you take initiative with family and doctor to express wishes
Forms are available for FREE at

13. Advance Directive: Disadvantages
Advance Directives (AD) may not be available when needed
Not readily available in patient charts
Living wills:
may not be specific enough
may be overridden by a treating physician
does not immediately translate into physician’s orders
Messages here:
Discuss where to keep advance directives and not
Make sure you give your health care agent a copy of your AD, plus family and doctor
Always complete a medical power of attorney document, not just a living will!

14. Medical Terms: End-of-Life Care Decision Making
Life-Sustaining Treatment
Artificial Nutrition and Hydration (tube feeding)
Cardiopulmonary Resuscitation (CPR)
Do-Not-Resuscitate Order (DNR)
Palliative Care
Hospice
Describe definitions of each.
Go to then ‘Advance Care Planning’, then ‘Glossary’ for definitions.

15. Other Directives
POLST
MOLST
Five Wishes

16. FREE Resources from CaringInfo.org
State-specific advance directive forms
Information on ‘Planning ahead’ and talking with loved ones and care providers
Brochures to download:
Understanding Advance Directives
You Have Filled Out Your Advance Directive… Now What?
End-of-Life Decisions
Conversations Before the Crisis
Ask Tough Questions
Communicating End-of-Life Wishes

17. QUESTIONS?

18. THANK YOU!