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Advance Care Planning isn’t just for people who are getting older. It is important for all adults to plan for future medical needs now because a serious accident or illness can happen at any age.

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Advance Care Planning
What Is Advance Care Planning?
Why Does Advance Care Planning Focus on Future Goals?

Advance Directive
What Kind of Form Do I Need to Complete?
Why Should I Complete An Advance Directive?
When Should I Complete An Advance Directive?

Choosing Your Health Care Agent
What Is the Role of a Health Care Agent and How Do I Choose Someone?

Legalizing Your Wishes
How Do I Make Sure My Advance Directive Is Valid?
What Should I Do with My Completed Advance Directive?

Additional Information
Where Can I Get More Information?

What Is Advance Care Planning?

Advance Care Planning helps adults at any age or stage of health understand and share their personal values, life goals, and preferences regarding future medical care. It is a gift you give your loved ones who might otherwise struggle during a medical emergency to make choices about your care.

Advance Care Planning is not a single decision; it is a process that occurs over a lifetime as goals and values change. Steps in the Advance Care Planning process include:

Thinking about your wishes for future care if you became seriously ill. Your wishes may be shaped by your experiences, cultural and religious views, your values and your goals.
Selecting a health care agent – someone that you trust to make medical decisions for you if you can’t make them yourself.
Discussing your wishes with your health care agent and other loved ones. This step is sometimes difficult, but it is a very important, and may help avoid future conflicts.
Completing an Advance Care Planning document, like an Advance Directive. In some situations, a health care provider might suggest also completing a Physician Order for Life-Sustaining Treatment (POLST) form.
Making copies and sharing copies with your health care agent, physicians and loved ones. Make sure that your Advance Directive is in your medical record.
Periodically reviewing your Advance Care Planning documents to be sure names, contact information and healthcare wishes haven’t changed.

The Advance Care Planning Continuum

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Ideally, Advance Care Planning begins in early adulthood with the completion of an Advance Directive and the naming of a health care agent. Your Advance Directive should then be reviewed and updated periodically throughout your life.

If you are diagnosed with a serious or chronic, progressive illness at any age, talk with your primary care provider about your treatment goals. If your goals include a preference for less aggressive treatment based on your current health condition, then completing a POLST form might be appropriate. The goal of Advance Care Planning is to ensure that your treatment wishes are known and honored.

Learn more about your rights to make medical decisions.

What Kind of Form Do I Need to Complete?

Advance Directive Forms

When most people think about Advance Care Planning, they think about completing an Advance Directive, also known as an advance healthcare directive. The law does not define which Advance Directive form you should use, just that the form includes some specific elements and instructions.

The standard Advance Directive form in California allows a person to do either or both:

Appoint power of attorney for health care (health care agent).
Give written instructions to your health care agent and health care providers.

Take note: Naming a power of attorney for health care is different from naming a financial or fiduciary power of attorney (someone who manages your finances). The two require different processes and forms.

A variety of Advance Directive formats are available. The following Advance Directive form meets California’s requirements:

For those who prefer a simpler form, an easy-to-read California Advance Directive called Prepare for Your Care is available in multiple languages with step-by-step instructions.

Other Advance Directive forms are specific to selected circumstances such as:

Jehovah’s Witnesses
Persons with early dementia
Persons with amyotrophic lateral sclerosis (ALS)

Many of these can be found on the Coalition for Compassionate Care of California website.

Note that not all Advance Directives are recognized by all states. Please check your state requirements before completing your Advance Directive.

Why Should I Complete An Advance Directive?

No one knows the future, but we can try to plan for it. For example, we have car insurance to protect us financially in case we get in an accident. When it comes to medical issues, most of us are used to making our own decisions regarding medical treatments we want or don’t want. Unfortunately, a serious illness or injury can suddenly make it impossible for us to communicate our wishes, and leave our doctors and loved ones guessing. Advance Care Planning can help us avoid putting this unnecessary burden on our loved ones and allows us to maintain some control over the care we receive. It allows physicians and families to feel confident that medical decisions are based on the goals and values of the patient, even when that person can’t speak in that moment.

Why Does Advance Care Planning Focus on Future Goals?

Medical care is always improving. New medical technologies and advancements in care allow medical professionals to effectively treat more conditions and potentially cure more diseases. But these same medical advancements can sometimes result in treatment that goes beyond what the patient wants. This can be avoided when care is aligned with the patient’s goals.

When physicians understand people's goals, they can recommend the medical treatments most likely to achieve those goals. When patients are not able to speak for themselves, their health care agent and others speaking on their behalf can confidently work with the medical team to fine-tune treatment choices to meet the patient's goals.

That is why Advance Care Planning focuses less on specific treatments, and more on the person’s values and goals for living. It's not so much about what the treatment does, as it is about what the treatment might mean for the patient's health or way of life. By focusing on the patient’s goals, the physician can recommend a treatment strategy most likely to help achieve those goals. See the Conversation example for more details.

When Should I Complete An Advance Directive?

Anyone over 18 years of age can and should complete an Advance Directive. Conversations about Advance Care Planning should be part of routine medical care because anyone can fall victim to a serious illness or injury.

Completing an Advance Directive becomes even more important for people with serious medical conditions, and for people with advanced illness or those at higher risk of losing their decision-making ability, Advance Care Planning becomes a critical need.

While Advance Care Planning is sometimes done during estate planning, it is not necessary to hire an attorney to complete an Advance Directive.

You need an Advance Directive if:

Medical personnel would not know who you want to speak for you in an emergency.
There is someone who you DON’T want to speak for you.
The person who you want to speak for you doesn’t know what you want.

What to Think About When Completing an Advance Directive

As you are preparing to complete an Advance Directive, you should think about:

If you could plan it today, what would the last days or weeks of your life look like?
- Who would be there with you?
- Where would you like to be?
What are your ideas and hopes about the end of your life?
What are your fears or concerns about the process of dying?
Have you thought about what kinds of care you might want -- or not want -- during a severe illness or when you are dying?
Where would you prefer to spend your last days if you are ill? At home, in a nursing home, or in the hospital?
Who do you want to make medical decisions for you if you are unable to speak for yourself?
Do you believe that life should always be preserved as long as possible? If not, what kinds of mental or physical conditions would make you think that life-prolonging treatment should not be used? For example, if you were:
- Unaware of your surroundings
- Unable to appreciate or continue important relationships
- Unable to think well enough to make everyday decisions
- In severe pain or discomfort
What are your wishes regarding a funeral? Burial vs. cremation?

What Is the Role of a Health Care Agent and How Do I Choose Someone?

A health care agent that you name in your Advance Directive has the authority to make nearly all medical decisions you would make if you were able, including:

choosing your doctor or other healthcare provider and where you will receive your care
speaking with your healthcare team about your condition and treatment options
reviewing your medical record and authorizing its release when needed
accepting or refusing medical treatments, including artificial nutrition and hydration and CPR
consenting to tissue and organ donation, authorizing an autopsy and arranging for disposition of the remains after death

The health care agent’s role is to be your voice – not to make decisions based on their own wishes. You should talk to your agent about your wishes so he/she knows how to speak for you. The more you tell your agent, the better he/she will be able to help make decisions as you would make them yourself, if you were able.

Naming Your Agent

Your health care agent should be someone who knows you well, someone you trust to follow your instructions and who is willing and able to act as your decision maker. It cannot be your health care provider or someone who works for your health care provider.

In choosing an agent, consider if he/she:

is legally able to serve as your agent (the person must be 18 years old; may not be your healthcare provider or her/his employee)
will be available when needed
is willing to speak on your behalf
knows you well and understands your values and beliefs
will be comfortable asking questions of your healthcare team, particularly related to issues such as treatment options
will do his/her best to make the healthcare decisions that you would make (whether or not he/she agrees with you)
will be able to “stand up” for you, be your advocate and handle conflict with others who might disagree with your wishes
can make difficult decisions under stress

It is important to talk to your health care agent to be sure they understand your wishes and are comfortable in carrying them out if the need arises. Talking to family members and telling them whom you have chosen as your agent and why can help prevent family conflict during an emergency.

How Do I Make Sure My Advance Directive Is Valid?

A legally valid Advance Directive must meet the following requirements:

It is a recognized and valid form of the Advance Directive in the state where it is completed
It is signed and dated by a person with decision making capacity
It is either:
- notarized
  OR
- witnessed by two people

If these requirements are not met, information in the Advance Directive might still be used to guide care, but the document might not stand up if there is a legal challenge.

Signing and Witnesses

Your Advance Directive isn’t considered legal until it is signed by you in the presence of two qualified witnesses OR a notary agent. Qualified witnesses are:

18 years of age
not the appointed Health Care Agent
not the person’s healthcare provider or an employee of the healthcare provider
not an employee of a nursing or residential care facility where person is living
one of the witnesses can’t be related to the person or entitled to any part of the estate

The witnesses are validating that you are the person signing the document; they do not need to read or agree with the content of your Advance Directive.

If you are living in a California nursing home, one of the witnesses must be a patient advocate or ombudsman.

What Should I Do with My Completed Advance Directive?

One of the most important things to remember about your Advance Directive is that it is not a secret document. Unlike a will, which might be locked in a drawer or stored in a safe, your Advance Directive should be kept in a place where it can be easily found if it is needed. In fact, it is a good idea to make multiple copies.

Make sure your health care agent has a copy—and that you’ve discussed with him/her what your wishes are.
Give a copy to your doctor or other primary care provider. You might want to make a specific appointment to discuss it with him/her. Ask your provider to put a copy of your Advance Directive in your medical record. Copies are just as valid as the original.

Where Can I Get More Information?

For more information about Advance Directives, ask your doctor, nurse or social worker for assistance. If you have any questions about completing an Advance Directive form, or if you need an Advance Directive form, you may contact the Office of Patient Experience 310-267-9113 for inpatients, or 310-794-1276 for ambulatory care patients. You may also ask your health provider for additional written material.