This post was written by Chris Brinneman, MSW, LCSW, manager, Advance Care Planning, Parkview Health.
Developing an advance directive involves thinking carefully about your values, medical preferences and who you trust to speak for you. When it comes to planning for the future, advance directives are one of the most compassionate gifts you can give—to yourself and to those who care about you. They ensure your healthcare wishes are known and respected if you are unable to speak for yourself. But, while the concept is straightforward, the process can feel overwhelming. That’s where “drilling down” into specific questions can help you move from vague intentions to clear, actionable instructions.
Often, people start with broad statements like “I don’t want to be kept alive on machines” or “I want them to try everything possible.” While these sentiments are important starting points, they can be interpreted in many ways. By asking yourself more detailed questions, you can create a directive that truly reflects your values, beliefs and preferences.
You could start this three-step process to prepare for a conversation to help you complete an advance directive:
- Clarify your values.
- Translate those values into specific medical preferences.
- Choose and talk with your healthcare representative.
Before talking about medical treatments, you should explore what matters most in life. These questions help anchor decisions in personal values rather than just medical possibilities. Consider:
- What does your absolute best day look like? What would you be doing that day? With whom?
- What are your biggest fears about medical care at the end of life? For example, do you fear pain, loss of dignity or being a burden? What does being a burden mean to you?
- What outcomes would you consider unacceptable? Would it be acceptable to you to be dependent on machines for your bodily functions?
- Do you have cultural or spiritual beliefs that would impact healthcare decision making?
Once your values are clear, you can connect them to specific treatment choices. These questions help you specify which interventions you would or would not want. Consider:
- Aggressive medication treatment: If your health changed significantly – for example, if you can no longer recognize the people who matter most, communicate or live independently – how would you want your care team to approach aggressive treatments?
- CPR: If your heart stops, do you want attempts to restart it? What do you truly know about the success rate of CPR? How might that impact your decision?
- Mechanical ventilation: Would you want to be placed on a breathing machine?
- Artificial nutrition and hydration: Would you want a feeding tube if you cannot eat or drink?
- Blood transfusions: Are there personal, religious or medical reasons to accept or decline them?
- Do you want trial periods for certain treatments? For example, you might be willing to try a ventilator for 7 days but want to withdraw if you are not improving.
- Are you receptive to hospice care at home, in a facility or wherever medically appropriate?
Advance care planning isn’t complete without identifying someone you trust to speak for you. Naming a healthcare representative ensures your stated values are honored and your voice is heard, even if you cannot speak. These questions help you choose the right person to speak for you:
- Who understands your values well enough to make decisions you would make?
- Can they handle stressful medical conversations?
- Are they willing to follow your wishes even if they disagree?
- Do you want one person or a primary plus an alternate?
- Can they advocate for you even if family members disagree?
Advance directives are not set in stone. You can update them as your health, beliefs or circumstances change. Thinking deeply about these questions isn’t easy, but it is an act of love and clarity. By drilling down into the specifics, you give your future self—and your loved ones—the gift of certainty in uncertain times.
We can help. Please reach out to our Advance Care Planning team. We can connect you to certified ACP facilitators to guide you through these questions that can help you complete an advance directive document. Schedule a free one-on-one appointment with a certified Advance Care Planning facilitator by calling 260-266-1481.
