Planning for Health Care Near the End of Life

Many older people think about how they want to dispose of their home and other property when they die. To assure this is handled as they wish, they make a will. They also can decide and document who will make financial decisions if age or illness no longer allows them to do so. Sometimes people are not aware they can also establish a plan for the health care they want near the end of life. This process is called advance care planning (ACP). An outcome of ACP is the completion of two legal forms, generally found in one document called an Advance Directive.

Often people delay in completing an advance directive because they don’t know where to obtain forms and worry how difficult it will be to complete them. A good resource is the “Prepare for Your Care” website at where an easy to understand video can guide you. You can also go to a link at the site to obtain the forms. The two parts of the form are described here:

1. A Health Care Power of Attorney (HCPOA) is where a person designates someone to be a medical decision maker to make health care decisions for a time that may come when a patient is unable to speak or make treatment decisions. This person may be referred to as your health care agent or surrogate. When choosing your agent, it is important to select someone who knows you and your wishes and values, who will be able to make difficult decisions, and understands how you would make decisions if you were able. He or she should not be afraid to ask difficult questions and advocate to doctors. You should have a conversation with the person you have chosen to confirm his/her willingness to act as your agent to increase the likelihood your wishes will be followed. If an agent is not named, the law provides for a representative to be designated. This person may not be someone you would choose. Further, an appointed representative may not have a clear understanding of your values and treatment choices.

2. In a Living Will (LW), you plan ahead for the medical treatment you receive as you approach the end of life. This can be difficult decision-making and often people want to discuss option with family members, a doctor, attorney or spiritual adviser, but it is not required. Your LW becomes effective only if you become incapacitated and have an end-stage medical condition or are permanently unconscious and there is no realistic hope for significant recovery. In the LW, you define your wish to not receive aggressive medical care, so you can die a natural death. Another choice would be aggressive treatment that could include cardiac resuscitation (CPR), a breathing machine or dialysis. Whatever you decide, the information will serve as instruction to your agent and your health care professionals. Once you have engaged in the process to identify your preferences and have completed the legal forms, you will need to have your health care directive signed by two witnesses. In Pennsylvania, notarization is not required. When you complete an advance directive, you should give a copy to your agent and to your doctor. It is also good to review your documents occasionally. Having a family meeting to share your decisions with your loved ones can be helpful. Family members are often comforted that they have an understanding of what Mom or Dad or another loved one would want when they can no longer get answers.

You can find more information at the following websites: … … Editor’s Note: This article was submitted by Marian Kemp, RN, of the Coalition for Quality at the End of Life (CQEL). She may be reached at