Many people are familiar with advance directives:  legal documents that convey personal decisions about end-of-life care ahead of time. They may provide a way to communicate wishes and avoid confusion if the person who completed the document becomes unable to express wishes and make medical decisions.    

While state laws and form vary from state to state, in general advance directives include:

• Written Instructions for Medical Care:  Called a Living Will in many states, this document describes the type of medical interventions a person wants withheld or used if they are close to death from a terminal illness or permanently comatose.  The descriptions and language vary significantly in these documents state to state.  However, living wills generally include person’s desire to avoid or receive “life prolonging” or “life sustaining” medical procedures such as mechanical ventilation, artificial nutrition and hydration and or cardiopulmonary resuscitation.  Some living wills also offer the option of expressing wishes about organ and tissue donation and mental health directives that most often take effect in cases of Alzheimer’s or dementia. 
  

• Written Authorization of Decision-Maker:  Called a Durable Power of Attorney for Healthcare or a Healthcare Proxy in many states, this document names a person who will make medical decisions if the individual is unable to do so.  Many states allow the person completing the document to name alternates if the primary named is not available.  
  

Some states have separate forms for the instructions and authorizations.  Others such as California and Texas combine the two into one form often called a Directive to Physicians.   

The barriers that keep people from accessing end of life care, such as fear of death, also keep people from completing advance directives.

Advance Care Planning Process and Communication Tips

This handout developed by Project Compassion outlines key steps in the advance care planning process and important communication tips.

To schedule a presentation on Advance Care Planning for your group or organization, contact  This e-mail address is being protected from spambots. You need JavaScript enabled to view it

NC Secretary of State Advance Health Care Directive Registry (www.sosnc.com)

This secure state-sponsored registry allows you to download NC documents for free.  For a fee, you may register your Advance Directives securely online.    

Caring Connections (www.caringinfo.org)

This consumer initiative of the National Hospice and Palliative Care Organization offers free downloadable Advance Directive documents and instructions for all 50 states and extensive information on topics like pain management, caregiving, hospice, and grief.  

Five Wishes (www.agingwithdignity.org)

The Five Wishes uses clear and understandable language to help explore end-of-life options and document wishes.  The Five Wishes functions as a fully legal advance directive in many US states.  Check the website for complete list.
 
Getting It Together, Planning Ahead Workbook and CD (also sold as Passing On Thoughtfully)

Featured in the Sunday New York Times, this printed workbook (and now the CD version based on the workbook) has become the gold standard for organizing important information about legal affairs, financial affairs, health affairs and wishes, final plans, and significant life events.  Click here to order.