Six Key Steps for Advance Care Planning

By Charlie Sabatino, Executive Director American Bar Association, Commission on Law and Aging

Step 1. Ask yourself this question: "What are your most important values and priorities in connection with decisions about serious life-limiting health conditions?"

  • Priorities and values may change at different stages of your life. An 18-year-old may not have strong preferences, but every decade of life brings experiences with the deaths of loved ones or friends and personal health issues. As values and preferences change through every age in life, planning is important for every age, too.
  • Use workbooks to help you explore your values more clearly. See the Resources List.
  • Talking with others not only helps, it's critical. See Step 3 below.

Step 2. Decide whom you want to make health decisions for you if you can't.

  • This is not always an easy question to answer. Sometimes the person closest to you may have the hardest time making decisions in the way you would want.
  • Unless you give the legal authority to someone, you leave yourself open to the kind of dispute that propelled the controversial Terri Schiavo case through the courts where loved ones fought over who was the appropriate decision-maker.

Step 3. Talk, talk, talk with your family, key friends and health care providers.

  • In addition to talking with the person you want to act as your health care agent, talking with other close family, friends and physicians is important to enable them to understand your health care priorities. If they are not at least minimally aware of your wishes ahead of time, they can create problems for your health care agent, even though your health care agent has legal authority. Don't rely solely on written documents because they can generate as many questions as answers.

Step 4. Put it in writing - in a Health Care Advance Directive.

  • A health care power of attorney is needed to give someone authority to speak for you when you can't. Every state has standardized legal forms for this, and these are very generally fine to use. A living will or medical directive form provides guidance about your beliefs and preferences; they may or may not be ideal, because they use standardized language that may not adequately reflect your unique priorities and values. Most often, these two types of forms are combined into a single advance document, but they do not need to be combined.
  • Look at different types of forms. See the Resources List.

Step 5. Make sure your advance directive is in the right place at the right time.

  • Give a copy to your health care agent, your doctor, and hospital, clinic or managed care plan.
  • A few states have state advance directive registries that will maintain an electronic copy of your form and make it available to certain health care providers when needed. There are also private national registries available that provide a similar service.
  • Some advance directive forms include a wallet card, but even a homemade wallet card is helpful.

Step 6. Review your plans when any of the "5 Ds" occur:

(1) Every new Decade of your life

(2) After the Death of a loved one

(3) After a Divorce

(4) After any significant Diagnosis

(5) After any significant Decline in functioning

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