Advance Directive and End of Life Care: Why Planning Matters

An advance directive is a legal document that outlines the type of medical care you want or do not want if you become too ill or injured to make or communicate decisions. 

These documents help guide family members and health care professionals during medical emergencies or serious illnesses when patients cannot express their preferences. 

Advance directives typically include instructions about treatments, such as: 

• Cardiopulmonary resuscitation (CPR) if your heart stops 
• Do-not-resuscitate (DNR) orders 
• Mechanical ventilation or breathing support 
• Pain management and comfort care 
• Organ and tissue donation 

Advance care planning documents generally address a patient's treatment preferences and designate someone to make medical decisions on a patient’s behalf if they become unable to do so. 

In California, advance care planning is typically documented in a single legal form known as an Advance Health Care Directive. This document allows individuals to: 

• Provide individual health care instructions outlining treatment preferences 
• Appoint a health care agent through a power of attorney for health care 

This section helps to make sure that a patient’s treatment preferences are known and respected if they are unable to communicate. It may include decisions about CPR, life-support treatments, such as mechanical ventilation and preferences related to allowing natural death. 

Some people choose aggressive treatment to prolong life, while others prioritize comfort-focused care and quality of life. These instructions also help guide care related to pain management, comfort and spiritual or personal needs. Documenting preferences helps ensure care aligns with a patient’s values and goals. 

This designation allows a patient to appoint a trusted person to make medical decisions on their behalf if they cannot do so. 

This individual is often called a health care proxy or agent. They communicate with clinicians and help ensure that medical decisions reflect the patient’s wishes. 

The person you choose may be a: 

• Family member 
• Close friend 
• Partner 
• Trusted caregivers 

Before naming an agent, discuss your expectations and the types of care you would want in different situations. This helps ensure your representative feels prepared and confident in carrying out your wishes.

Health care teams generally follow the agent’s decisions unless the requested treatment is medically inappropriate, ineffective or harmful. Because circumstances and personal priorities can change, it’s important to review your advance directive periodically and update it as needed. 

Another document to consider, when appropriate, is a Physician Orders for Life-Sustaining Treatment (POLST) form.

A POLST complements but does not replace an advance directive. A health care provider discusses treatment options with the patient before the form is completed and signed.

POLST forms provide specific medical orders that health care providers can follow immediately during an emergency. They are generally intended for people who are seriously ill or medically frail. 

Because it is a medical order, the POLST form travels with the patient across care settings and are generally followed by health care providers. 

Medical planning is just one aspect of preparing for the future. Many people incorporate advance directives into broader legal and financial planning.

For example, individuals often discuss their preferences with: 

• Financial advisors 
• Estate planners 
• Attorneys 
• Family members 

These conversations help ensure that medical decisions are coordinated with other important documents, such as wills, trusts or long-term care plans. 

Working with legal and financial professionals can help ensure that care preferences are clearly documented and consistent with overall estate planning goals. 

Adults, 18 and older can obtain advance directive forms from several sources, including: 

• Their physician or health care provider 
• Hospitals or health systems 
• State health agencies 
• Trusted organizations that focus on end-of-life care 

Once completed, it is important to share copies with key individuals. Consider taking the following steps: 

• Add the document to your medical record 
• Provide copies to your health care proxy or agent 
• Share the directive with family members or caregivers 
• Bring a copy to your medical appointments 

Some people also register their directive with the California Advance Health Care Directive Registry so providers can access it if needed. 

Discussing your wishes with health care professionals can help ensure that your directive reflects your goals. 

“It is important to have a conversation with your clinician about your health and what type of care you would want,” Dr. Lakshman says. “Advance directives and POLST forms help communicate these health care choices. They also designate who would help with decisions if you were no longer able to express your goals.” 

Educational resources and forms are available through the National Hospice and Palliative Care Organization, which provides information about advance directives and end-of-life care planning. Starting the conversation today can help ensure your life care reflects your priorities and gives your loved ones greater peace of mind. 

At Scripps, physicians, nurses and palliative care specialists work together to help patients and families navigate advance care planning and make informed decisions during serious illness.