Checklist for writing an advance directive

A living will and a medical power of attorney (appointment of a health care agent) are types of advance directives. These documents explain your health care wishes in case you become unable to speak or otherwise communicate for yourself, such as if you become severely injured or seriously ill.

Depending on what state you live in, the advance directive form may have specific questions or issues for you to address, or it may be more flexible. The following questions may help you consider what kind of information to include in your advance directive.

1. Who do you want to make decisions about your medical care if you are not able to?
   • Do you have a specific person in mind, such as a spouse, child, or doctor? (Some states do not allow your treating doctor to serve as your health care agent.) Do you feel this puts too much of a burden on the person? How do you think you would feel after talking with this person about the kinds of treatments you would want and not want?
   • Do you expect that your friends, family, and/or others will support your decisions about medical treatment you may need now or in the future?
2. Do you feel you know enough about these life-sustaining medical treatments?
   • Cardiopulmonary resuscitation, also called CPR (used if your heart stops beating)
   • Mechanical ventilation (used if you cannot breathe on your own)
   • Kidney dialysis (used if your kidneys stop working)
   • Artificial nutrition (used if you are unable to eat food) and artificial hydration (used if you are unable to drink fluids)
   • Antibiotics (used to treat an infection that would be life-threatening if not treated, such as pneumonia)
3. How do you feel about the use of these life-sustaining treatments if you:
   • Are terminally ill?
   • Are in an irreversible coma?
   • Have an irreversible chronic illness (for example, Alzheimer's disease)?
4. What are you most afraid of having happen? You may be concerned about pain, loss of independence, being kept on life-support machines, or being a burden to your family. Address these fears in your advance directive.
5. What do you consider an acceptable quality of life? Address these issues in your advance directive.
   • Is living independently in your own home important to you?
   • Is living in a hospital or nursing home or on life support acceptable?
   • Do you have any general comments about the value of independence and control in your life?
6. Where would you prefer to die (for example, in a hospital or in your own home)?
7. How would you describe your current health? If you have any medical problems, do they affect your ability to live your life as you wish?
8. Do you want to donate organs when you die?
9. How well do you communicate with your doctor? Do you feel comfortable talking with him or her about end-of-life issues?
10. Do you have religious beliefs that are in conflict with the concept of a living will? Some people disagree with living wills for spiritual or religious reasons. It may be helpful to talk with your spiritual advisor about how to manage decisions about your medical treatment if you cannot speak for yourself.
11. Are you worried that you may not be able to practice rituals that are important to your religion before you die? If your religion has specific ceremonies that are done before or after someone dies, you can specify in an advance directive that you want these services, and who you would like to do them, if possible. (However, some hospital policies may not allow you to practice certain rituals.)
12. What other concerns do you have? Do you have any general comments about your attitude about illness, dying, and death?

Some people find it helpful to try the following exercise to help clarify their wishes. Write down what comes to mind when you think about these situations.

Imagine yourself in a situation in which you cannot make decisions for yourself.

• If you had a terminal, irreversible disease, would you want to be treated with antibiotics to cure an infection that might lead to your death, such as pneumonia?
• If you had a progressively debilitating disease, such as Parkinson's disease or Alzheimer's disease, would you want to receive artificial (tube or IV) fluids and nutrition? If so, is there a point at which you would want this treatment stopped?
• If you were in pain, would you want aggressive treatment to manage your pain, even if it might shorten your life?
• How would your doctor's opinion about your chances of recovery affect what kind of treatment you would want in these and other situations?

Do this again for a few more imaginary situations. You may see some patterns develop that can be helpful as you write your advance directive. You may want to share your thoughts with your doctor to see if your expectations are accurate and to gather more information.