Advanced Care Planning (ACP) is a proactive process of preparing for future medical decisions if you become unable to communicate your wishes. It involves understanding and sharing your personal values, life goals, and preferences regarding health care. This conversation-based approach ensures your voice is heard, regardless of how complex your medical situation may become. Engaging in ACP helps reduce the stress and burden placed on family members and medical providers who might otherwise have to guess what treatments you would want. This process is recommended for any adult, beginning at age 18, because a medical crisis can happen unexpectedly at any stage of life.
Advanced Directives: The Planning Tools
Advanced Care Planning is formalized through legal documents known as advance directives, which provide written instructions for your future medical care. The specific requirements for these forms are governed by state law, making it important to use the correct documents for your region. Advance directives generally comprise two distinct instruments.
Living Will
The Living Will details the types of medical treatments you would or would not want to receive. This includes preferences regarding life-sustaining measures such as mechanical ventilation, cardiopulmonary resuscitation (CPR), and artificial nutrition and hydration. It provides explicit direction to your health care team and family.
Durable Power of Attorney for Health Care (DPOA-HC)
The second document is the Durable Power of Attorney for Health Care (DPOA-HC), often called a Health Care Proxy or Agent. This legal instrument designates a specific person to act as your authorized voice for medical decisions. Unlike the Living Will, which is static instruction, the DPOA-HC empowers a trusted individual to interpret your wishes and make real-time treatment choices based on your known values. Naming an agent allows for flexible decision-making that a written document alone cannot provide.
Clarifying Advanced Care Planning vs. Palliative and Hospice Care
The terms Advanced Care Planning, Palliative Care, and Hospice Care are often confused, but they represent distinct concepts related to managing serious illness. ACP is the overarching process of discussion and documentation that can begin at any time, even when a person is perfectly healthy. It is not a type of treatment or a place of care, but rather the preparation that informs all future medical decisions. The resulting advance directives guide treatment, whether that treatment is curative, palliative, or hospice-focused.
Palliative Care
Palliative care is specialized medical care for anyone living with a serious illness, aimed at relieving symptoms and improving quality of life. This care focuses on issues such as pain management, shortness of breath, and nausea, and is delivered by an interdisciplinary team. Palliative care can be provided at any stage of an illness and can occur simultaneously with curative treatments, such as chemotherapy or surgery. The goal is to provide support while patients pursue treatment for their disease.
Hospice Care
Hospice care is a specific form of palliative care reserved for individuals nearing the end of life, typically when a physician determines the patient has a prognosis of six months or less. When a person enters hospice, the focus shifts entirely away from curative treatments toward comfort, quality of life, and emotional and spiritual support. Hospice care is generally initiated after the patient and their physician have agreed to stop attempts to cure or slow the underlying disease.
Selecting and Empowering Your Health Care Agent
Choosing the person to serve as your Health Care Agent requires careful consideration beyond simply selecting a closest relative. The agent should be someone who knows you well and understands your values and priorities for life. This individual must be willing to discuss sensitive, hypothetical scenarios, such as when you would want to discontinue life support or what level of cognitive function you would consider acceptable. This open communication is fundamental to empowering the agent to act as your true representative.
The person you select must also possess the strength and assertiveness to advocate for your wishes, even in the face of disagreement from other family members or medical providers. They need to be calm under pressure and capable of asking difficult questions to the care team to ensure decisions align with your preferences. Proximity and age should also be considered; an agent who is geographically accessible and likely to outlive you offers practical advantages. Once appointed, your agent’s authority is to make health care decisions on your behalf, except for those treatments forbidden in your Living Will.
When the Plan Takes Effect
The instructions and authority outlined in an Advanced Care Plan are not activated immediately upon signing the documents. The plan only takes effect when a patient loses decisional capacity, meaning they are unable to understand the medical information presented, appreciate the consequences of their choices, and communicate a clear decision. This determination is made by the attending physician, often in consultation with other medical professionals, and signifies the moment the agent’s authority begins. If the patient later regains capacity, the agent’s decision-making authority is immediately suspended, and the patient resumes control of their own care.
For the plan to be effective, accessibility of the documents is paramount in a medical crisis. Copies of the signed advance directives should be kept by the agent, your primary care physician, and potentially uploaded to your electronic health record or a state registry. Carrying a card that identifies your agent and where the documents are stored can also be beneficial. The plan is not static; it should be reviewed and updated periodically to ensure it still accurately reflects your current values and goals. Updates should occur after a new diagnosis, a major change in health status, a significant life event, or at least every five to ten years.