The Millennial Geriatrician

Advance Care Planning: A Guide for You and Your Family

Have you ever thought about what kind of medical care you would want if you became too sick to speak for yourself? It’s not the easiest topic to bring up, but it’s one of the most important conversations you can have, for yourself and for the people you love. That’s what advance care planning is all about.

What Is Advance Care Planning?

Advance care planning is the process of thinking about, talking about, and writing down your wishes for future medical care. It’s not just about end-of-life decisions. In fact, it’s something best planned when you’re well and healthy! I also acknowledge that there are some cultural sensitivities broaching this topic (and culturally concordant care approaches deserve their own page, which is hopefully soon to come). It’s about making sure your values and preferences guide your healthcare at every stage, especially if ever you can’t communicate them yourself.

This process typically involves three key steps:

– Reflecting on what matters most to you in life and in your health

– Talking with your loved ones and your doctor about those values

– Putting your wishes in writing through legal documents

Why Does It Matter?

Every adult, regardless of age or health status, can benefit from advance care planning. Unexpected accidents, strokes, or sudden illnesses can happen at any age. Without a plan in place, your family may be left guessing what you would have wanted… and that can lead to confusion, disagreement, and emotional distress during an already difficult time.

Research consistently shows that when people engage in advance care planning, they are more likely to receive care that matches their wishes. Their families also report less anxiety and guilt when making decisions on their behalf. In short, advance care planning is a gift to the people you care about most.

The Key Documents You Should Know About

There are a few important documents that make up a complete advance care plan:

1. Advance Directive (Living Will): This is a written document that spells out what types of medical treatments you would or would not want if you were unable to make decisions. For example, would you want to be placed on a breathing machine? Would you want CPR if your heart stopped? Would you want tube feeding? There are no right or wrong answers – only your answers.

2. Healthcare Power of Attorney (Healthcare Proxy): This document names a person you trust – your “agent” or “proxy” – to make medical decisions on your behalf if you cannot. Choosing the right person is critical. Pick someone who knows you well, can handle pressure, and, most importantly, will honor your wishes even if they personally disagree.

3. POLST or MOLST Form: If you have a serious illness or are nearing the end of life, your doctor may discuss a POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) form with you. Unlike an advance directive, this is a medical order signed by your doctor that travels with you and is immediately actionable by emergency responders and hospital staff.

How to Get Started

Starting the conversation can feel awkward, but it doesn’t have to happen all at once. Here are some practical tips:

– Start with your own reflection. Think about what a good day looks like for you. What activities make life worth living? What would you consider an unacceptable quality of life? These reflections will guide your decisions.

– Pick the right moment. You don’t need to wait for a health crisis. Many families find it natural to bring up the topic after a life event: a friend’s illness, a news story, or even a routine doctor’s visit.

– Talk to your loved ones. Share your values and preferences with your family, especially the person you would choose as your healthcare proxy. Be specific. Saying “I don’t want to be kept alive on machines” is a start, but it helps to discuss specific scenarios with your doctor.

– Talk to your doctor. Your primary care provider can help you understand your options and fill out the appropriate forms. Don’t be afraid to bring it up! Doctors welcome these conversations.

– Put it in writing and share it. Once your documents are complete, give copies to your healthcare proxy, your doctor, and your local hospital. Keep a copy somewhere easy to find at home. Review and update your plan every few years or after any major life or health change.

A Few Common Myths

– “Advance care planning is only for the elderly.” Not true. Any adult over 18 should have at least a healthcare proxy in place.

– “If I sign a Do Not Resuscitate order, the doctors won’t treat me.” Absolutely not. A DNR only means CPR will not be performed if your heart stops. You will still receive all other appropriate medical care.

– “I can’t change my mind.” You can update your advance directive at any time, as long as you are able to make decisions.

The Bottom Line

Advance care planning isn’t about giving up hope, it’s about taking control. It ensures that your voice is heard, even when you can’t speak. It protects your family from the burden of guessing. And it helps your medical team provide the care that truly reflects who you are and what you value.

Start the conversation today. Your future self & your family will thank you.