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Ensure your Wishes for Medical Treatment are Followed

Here we describe our recommended five step process for ensuring your wishes for medical treatment will be followed. Critical to this process is the completion of an Advanced Care Plan.

There is much more to writing an Advance Care Plan than simply filling in a form. The most important part of the planning process is to take time for reflection and discussion to ensure your Plan reflects your values, beliefs and wishes.

Step 1
Understand all Your Choices
The first step in completing an Advance Care Plan is to understand all the end-of-life choices that are available to you. You can read all about your end of life choices here.
Step 2
Reflect and Discuss
Once you've read about and understand your options, pause. The decisions you need to make about end of life care are critical. Take some time to reflect on your available choices and to discuss them with your loved ones.

Our Advanced Care Planning Kit can guide you through these discussions by providing specific scenarios to consider. For example: Imagine that you are physically frail and you need help with most routine daily activities, such as dressing, bathing, eating and going to the toilet. You live in a nursing home and your mind is fairly clear and capable most of the time. You have had pneumonia or other lung infections four times in the last year. Each time you had to be hospitalized for several days and given antibiotics through an IV tube. The next time you get pneumonia, do you want aggressive antibiotic treatment again or just comfort care until death comes?

Think about your decisions in the context of your values, beliefs and wishes. Remember, as long as you are competent to make and express your own wishes, you will be asked to do so. You are preparing an Advance Care Directive in case others need to make end of life decisions on your behalf.
Step 3
Make Your Decisions
Once you've reflected on and discussed your choices, make the decisions that feel right for you now. Remember, as long as you are competent to speak for yourself, you will be making and communicating your decisions as the questions arise.

The purpose of the Advance Care Directive is to leave clear information in writing so that your substitute decision maker can make the decisions for you that you would want for yourself - if you are not able to speak or otherwise comunicate on your own behalf. Finally, remember that you can change your Advance Care Directive at any time. (We recommend reviewing it annually.)
Step 4
Document Your Decisions
When it comes to end of life decisions, what you've put in writing will carry much more weight than what you've mentioned in passing. It can also make it easier for your Substitute Decision Maker to act on your wishes. So put it in writing! You can use the forms in our Advance Care Planning Kit or have a lawyer or notary draw up your Directive. It's up to you.
Step 5
Communicate Your Decisions
Now that you have an Advance Care Plan, let others know. The most critical person to know is your Substitute Decision Maker (SDM). After reading your Plan, arrange to have both you and your SDM take the quiz in our Advance Care Planning Kit to ensure that your thinking is aligned.

Give a copy of your plan to your SDM. If you carry a cell phone, create a contact for ICE (in case of emergency) and enter the telephone number of your Substitute Decision Maker. In more and more jurisdictions, healthcare professionals are trained to look for contact information under this heading.

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