It’s time to talk about advance directives

November 11, 2022 Providence Health Team


In this article:

  • November is National Hospice and Palliative Care Month and a fitting time for advance care planning.

  • An advance care directive ensures you receive the medical care your desire when you are unable to speak for yourself.

  • Our four-step process: Think, talk, choose and complete can help make this overwhelming conversation manageable.

An advance care directive (ACD) outlines your wishes and preferences for end-of-life medical care. This is obviously a very tough subject for some, so it’s no surprise that only 46% of U.S. adults between the ages of 50 and 80 years of age have one. And only two in five adults have even broached the subject with a loved one. Reasons for avoiding the conversation range from not getting around to it to simply not wanting to think about or discuss it.

Discussing end-of-life care isn’t just for older adults, either. An advance care directive outlines your wishes when you’re unable to speak or advocate for yourself due to injury or illness – something that can happen at any stage of life.

While discussing and documenting your wishes for end-of-life medical care may be difficult, it’s an important step to take. That’s because an advance care directive can benefit everyone involved in your care:

  • Medical care teams have a clear understanding of your treatment goals and can recommend a plan that meets those desires.
  • Family members may feel less stress about having to make difficult decisions and have less conflict between themselves when deciding next steps.
  • An advance care directive can also help improve the bereavement experience among your loved ones.

And, of course, an advance care directive will ensure that your wishes are followed during end-of-life care.

Understanding what’s in an advance care directive

An advance care directive allows you to clearly express your preferences for care when you cannot speak for yourself. Those preferences may include:

  • CPR (cardiopulmonary resuscitation). CPR or defibrillation may be used to restart a beating heart. This life-saving measure can resume normal heartbeats in young, otherwise healthy people. Occasionally, CPR does not succeed in older adults with multiple, serious health conditions.
  • Ventilator. A ventilator is a machine that helps you breathe. You will likely be sedated if placed on a ventilator and may not be able to speak.
  • Artificial nutrition and hydration. A feeding tube and IV (intravenous) fluids can be given near the end of life to help prolong your life. While these measures can be helpful when recovering from surgery or illness, there is no research that suggests they meaningfully prolong life.
  • Comfort care. Comfort care is just what the name implies – care measures that can be taken to help you feel more comfortable at the end of life. This may include medicine for pain, anxiety or constipation; ways to manage shortness of breath; and spiritual or emotional counseling.

Navigating emotional decisions

The process of planning and creating an advance care directive is called advanced care planning. And it isn’t one you can do on your own. While the choices are ultimately yours and yours alone, it’s helpful to discuss your preferences with a trusted loved one and a professional.

The Institute for Human Caring is dedicated to advancing whole person caring across Providence. We do this by supporting and advocating for your involvement and respect for your choices throughout your care. That includes:

  • Every patient will have personalized plans of care and will receive treatments that are consistent with their individual goals and priorities.
  • Every adult patient will have a trusted decision maker or advance directive in their electronic medical record.
  • Every seriously ill patient will have at least one goals-of-care conversation prior to major surgeries or intensive medical treatments.
  • Every patient at every age and stage of life will be routinely assessed to address their physical, functional, emotional, social and spiritual well-being.
  • Every seriously ill patient will have access to specialty palliative care.
  • Every patient will receive ethical care consistent with best-known processes and practices.

Learn more about The Institute for Human Caring.

Starting the advance care planning process

Creating your advance care directive takes time. It requires deep thought, honest conversation and preparation to create a document you are comfortable with. It’s also not a one-and-done process. You should regularly review your advance care directive and update it if your preferences or health should change.

Here are four steps to consider when creating an advance care directive.

Step 1: Think

It may sound obvious, but the first place to begin planning your directive is to think about it. Ask yourself a few hard questions, such as:

  • How have people you’ve known been cared for at the end of their lives?
  • What would you do differently or keep the same?
  • What makes life meaningful to you?
  • What do you find most important in life?

It can be tough to know how to begin to identify and outline your wishes. Here are a few questions to help get you started:

Advance care planning series: Think

Step 2: Talk

Chances are you won’t have just one conversation with one person. It’s much more likely that you’ll have many discussions with those you love regarding your issues. This can be done during a formal conversation: Perhaps you have your partner, children or other loved ones over for dinner to discuss your wishes. Or, maybe it’s an easier subject to broach in smaller, more natural conversations. Watching a TV show or movie together that centers around these types of situations can be a good way to start or add to past conversations.

Here are some more helpful tips on how to talk about advance care planning with loved ones:

Advance care planning series: Talk

Step 3: Choose

After you’ve thought about it and talked with family members, it’s time to select who your healthcare agent will be. A healthcare agent is an individual whom you appoint to make decisions about your medical care if you are unable to speak for yourself. A healthcare agent has the legal right and responsibility to communicate your preferences and speak directly with your healthcare team about many different decisions, including:

  • Using life-sustaining treatment
  • Starting treatment or medication
  • Stopping treatment or medication
  • Agreeing to organ donation

Learn more about the role of a healthcare agent.

Advance care planning series: Choose

Step 4: Complete

Once you’ve identified a healthcare agent and are confident with your end-of-life care preferences, it’s time to complete your document. An advance care directive is a legal document but filling it out isn’t as difficult as it may seem. The Institute of Human Caring created an advance care directive toolkit to make working through your choices and completing the appropriate documentation easy.

When your document is finished and signed by the appropriate people, resist the temptation to file it away and forget about it. Review it periodically – once or twice a year or if you experience any major life changes such as divorce or after receiving a new diagnosis.

Learn more about completing your advance care directive.

Advance care planning series: Complete


Find a doctor

Your primary care provider or specialty physicians can help answer any questions you may have about advance care planning and provide you with the documents you may need. If you need to find a doctor, you can use our provider directory. Through Providence Express Care Virtual, you can also access a full range of health care services.

Download the Providence App

We’re with you, wherever you are. Make Providence’s app your personalized connection to your health. Schedule appointments, conduct virtual visits, message your doctor, view your health records, and more. Learn more and download the app.

Related resources

Advance care planning series: Think

Advance care planning series: Talk

Advance care planning series: Choose

Advance care planning series: Complete

For people who don’t have an advance care directive, this quick form could be the next best thing


This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.

About the Author

The Providence Health Team brings together caregivers from diverse backgrounds to bring you clinically-sound, data-driven advice to help you live your happiest and healthiest selves.

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