Why is this important?
A key part of estate planning is documenting your healthcare and end-of-life preferences for situations where you may be unable to communicate your wishes. Planning in advance can help ensure that your values and priorities guide medical decisions if you cannot speak for yourself.
There are generally two components to this planning.
- First, you can name someone to make healthcare decisions and communicate with medical providers on your behalf. This is typically done through a Health Care Power of Attorney or by appointing a Health Care Agent or Representative.
- Second, you can document your preferences about the type of care you would want—or not want—in certain situations. This may include decisions about life support, organ donation, the disposition of your remains, and preferences for memorial or funeral services.
Preparing these documents can relieve a significant emotional burden from family members who might otherwise need to make difficult decisions without knowing your wishes. Even if you do not have strong preferences about specific medical treatments, naming a trusted person to make decisions on your behalf is generally recommended.
It is also important to note that these two components—naming an agent and documenting your wishes—may take different forms depending on the state and the medical system involved. The exact format of the document is less important than ensuring that it clearly reflects your choices and instructions.
General health care decision-making authority
Your Health Care Agent has the authority to make healthcare decisions for you if you are unable to communicate your wishes. You may provide specific guidance to your agent through written instructions, but if you do not, your agent must act based on your known values or, if those values are unknown, in your best interests.
This standard is often called substituted judgment. It means your agent should consider your personal values, religious beliefs, and views about quality of life when making decisions. When facing complex medical situations, the agent may consult with doctors, healthcare providers, or legal advisors to ensure that decisions are thoughtful and consistent with your wishes.
General responsibilities of a Health Care Agent
- Medical treatment decisions
Your agent may consent to, refuse, or discontinue medical treatments other than certain life-support measures. This can include decisions about surgeries, medications, and other medical interventions. - End-of-life care decisions
If necessary, your agent may make decisions about continuing or withholding life-support treatment. These decisions may include whether to authorize forms such as a Do-Not-Resuscitate (DNR) order or a Portable Orders for Life-Sustaining Treatment (POLST) form.- In general terms, life support refers to treatments that keep you alive when death would otherwise occur soon or immediately. Examples include CPR, artificial ventilation, and artificial nutrition or hydration.
- Accessing medical records
Your agent can access your medical records and communicate with healthcare providers to understand your medical condition and treatment options. - Living arrangements and long-term care
Your agent may decide where you should receive care if you cannot remain at home. This might include choosing a hospital, rehabilitation center, skilled nursing facility, or other care setting. - Hiring and changing healthcare providers
Your agent may select or change doctors, hospitals, and other healthcare providers to help ensure that your care meets your needs.
Considering additional healthcare preferences
You may wish to include specific instructions to guide your Health Care Agent in certain situations. The following topics are examples that some people choose to address in their healthcare planning.
- Psychiatric or behavioral health care
In many states, additional authorization is required for an agent to consent to psychiatric hospitalization or certain behavioral health treatments. If mental health care may be relevant to your situation, it may be helpful to discuss whether a specialized mental health directive should be created with your physician. - Preferred place of care
You may wish to express a preference about where you would prefer to receive care. For example, some people prefer home-based care whenever possible, while others prefer hospital care in serious medical situations. - Care and custody of minor children
If you have minor children, you may want to consider whether the person you name as your Health Care Agent would also be suitable to make medical decisions for your child if both parents were unable to do so. - Religious beliefs and traditions
Healthcare planning may also reflect religious or cultural beliefs. Some individuals have specific views about medical treatments, pain management, life support, or spiritual support during illness. - Existing health conditions
If you have been diagnosed with a serious or progressive illness, healthcare planning may involve discussing treatment goals, quality-of-life considerations, and symptom management. In some cases, a POLST form may be appropriate in addition to an advance directive. - Future cognitive decline
Some individuals wish to plan for the possibility of conditions such as Alzheimer’s disease or other forms of dementia. In these situations, people often reflect on their preferences regarding independence, quality of life, and long-term care options.
Considering end-of-life care preferences
You may also document your wishes for situations involving terminal illness, irreversible coma, or permanent loss of cognitive function. Clearly expressing your preferences can help reduce uncertainty and emotional strain for loved ones who might otherwise need to make difficult decisions without guidance.
- Life support
- Life support generally refers to medical treatments that keep a person alive when death would otherwise occur. Examples include CPR, mechanical ventilation, and artificial nutrition or hydration.
- If you have expressed preferences about life-support treatment, your Health Care Agent will communicate those wishes to your medical team. If no specific preferences are documented, your agent may make decisions on your behalf.
- Religious practices at the end of life
- Some people wish to include instructions related to religious or spiritual practices during illness or at the end of life. This might include requesting visits from clergy, observing certain rituals, or following traditions related to burial or cremation.
- Organ donation
- Many states maintain organ donation registries that allow individuals to indicate their willingness to donate organs and tissues after death. Donations may include organs such as the heart, lungs, liver, kidneys, and pancreas, as well as tissues such as corneas, skin, and bone.
- You may already be registered as an organ donor through your driver’s license or a state registry. If not, you may choose to state your preferences within your planning documents.
- Donation of the body for scientific research
- Some individuals choose to donate their body to scientific or medical research. If you are considering this option, it is often necessary to coordinate directly with the medical school or research institution that accepts such donations. These programs usually have their own consent forms and procedures.
Binding instructions versus guidance
Your healthcare documents may specify whether your preferences are binding instructions that your agent must follow or general guidance that your agent should consider when making decisions.
Binding instructions can help relieve your agent of the emotional burden of interpreting your wishes in difficult situations. However, some people prefer to allow flexibility so that their agent can respond to unforeseen medical circumstances.
Reflecting on your values
When thinking about healthcare and end-of-life planning, it may be helpful to reflect on your values and beliefs about medical treatment, quality of life, and personal dignity. Some people find it useful to write a personal statement or complete a values worksheet to clarify their preferences.
It is not necessary to address every possible scenario in your documents. In many cases, providing general guidance and appointing a trusted agent to make decisions on your behalf may be the most practical and supportive approach.