5 Things to Include in Your Advance Directive

Most people know they should have an advance directive. Far fewer actually have one. And those who do, many have documents that are incomplete, outdated, or so vague that they don't give their loved ones much to go on when it matters most.

If you've been putting this off or if you have a document but aren't sure it's doing what you need it to do this is for you.

First, What Is an Advance Directive?

An advance directive is a legal document that has your wishes for medical care in the event you become unable to speak for yourself. It can cover everything from life-sustaining treatment to pain management to who is authorized to make decisions on your behalf.

In California, the most common forms are the Advance Health Care Directive and the POLST (Physician Orders for Life-Sustaining Treatment) form, which is typically used when someone already has a serious illness.

Having one doesn't mean you're giving up. It means you're taking control.

1. Who You Want to Make Decisions for You

This is called your healthcare agent or durable power of attorney for healthcare. It's the person who will speak on your behalf if you can't speak for yourself.

Choose someone you trust completely, not necessarily the person who loves you most, but the person who can stay calm under pressure, advocate clearly, and honor your wishes even when it's hard. Talk to them before naming them. Make sure they understand what you want and are willing to carry it out. This is a VERY important step. Think about this thoroughly. 

Here are some additional questions to consider from The National Institute on Aging 

• Am I comfortable talking with this person about my wishes and priorities for health care?

• Will this person honor my wishes and do as I ask when the time comes?

• Do I trust this person with my life?

• Can this person handle conflicting opinions from my family, friends, and health care providers?

• Does this person live near me or would they travel to be with me if needed?

• How do they respond under pressure? 

2. Your Wishes Around Life-Sustaining Treatment

This is the part most people find hardest to think about, but it's also the most important. Your directive should clearly state how you feel about interventions like:

• CPR and resuscitation

• Mechanical ventilation (breathing machines)

• Artificial nutrition and hydration (feeding tubes)

• Dialysis

You don't have to say a blanket yes or no to everything. You can specify under what circumstances you would or wouldn't want certain treatments. For example, "I would want CPR attempted if there is a reasonable chance of recovery, but not if I have a terminal illness with no chance of meaningful recovery."

The more specific you are, the more useful your document will be.

3. Your Pain Management Preferences

Many people fear pain at the end of life more than death itself. Your advance directive can and should include your wishes around comfort care and pain management, including whether you want to be kept comfortable even if doing so might hasten death.

Being clear about this gives your medical team and your loved ones permission to prioritize your comfort without second-guessing themselves.

4. Your Wishes Around Dying at Home vs. in a Facility

Where do you want to be when you die? At home? In a hospice facility? In a hospital only if necessary? This is something many people have strong feelings about but never put in writing.

Stating your preference doesn't guarantee it will be possible in every circumstance, but it gives your loved ones a clear direction to work toward and removes the weight of them having to guess.

5. Personal Values and What Matters Most to You

This is the section most advance directive forms leave out, and it's one of the most valuable things you can add. A few sentences about your values, what makes life meaningful to you, what you're most afraid of, what a good death looks like in your mind, this gives your healthcare agent crucial context when they face decisions your document doesn't specifically address.

Think of it as a letter to the people who will be making decisions for you. It doesn't have to be long. It just has to be honest. This is also a good way to start the conversation with your healthcare agent - you can give it to them to read and then discuss it. 

You Don't Have to Do This Alone

Completing an advance directive is one of the most loving things you can do for the people in your life. It lifts an enormous burden from their shoulders at a time when they're already grieving.

If you're not sure where to start, or if you want someone to sit with you and talk through your wishes before you put them on paper, that's exactly the kind of support a death doula can offer. I linked a couple versions of a Healthcare Directive on my resources page. 

Have questions about advance directives or end-of-life planning? Reach out, I'm happy to talk through it with you. You're also welcome to book a free discovery call to explore what support might look like for your situation.