The process of talking about the kind of medical treatment a patient would or would not want if they become unable to make decisions for themselves. This includes preferences like where they want to receive care and who they want to make decisions for them. The goal is to record the patient’s wishes to ensure their care meets their values and involves people important to them.

Advance directives are legal documents that allow you to share your healthcare preferences and name someone to make decisions if you are unable to. These usually include 3 types: Medical Durable Power of Attorney (MDPOA), Living Will, and a Cardiopulmonary Resuscitation (CPR) Directive. 

This document allows a patient to choose a person, who is assigned as the Medical Durable Power of Attorney (MDPOA), to make medical decisions for the patient if they are unable to do so themselves. The MDPOA acts on the patient’s behalf if they have a serious medical condition that prevents decision-making.

This is a written document that specifies what kind of medical treatment a person wants or does not want. A living will can be very specific or very general.

Example: people can include instructions like, “If I am terminally ill, I do not want life-support that would only prolong my dying.”

A more detailed living will may include information about the use of analgesia (pain relief), antibiotics, hydration, feeding, and ventilators or cardiopulmonary resuscitation (CPR).

A type of care that provides an extra layer of support, focusing on relieving pain and other symptoms for people with severe illness. It also provides emotional, social and spiritual support to patients and their family. Palliative care can be provided at any stage of a patient’s illness, not only in the last few days of life. The objective is to support patients to live as well as possible during their recovery from a severe illness, or until they die.

Example: if you have cancer, palliative care might help relieve the pain from tumors and provide counseling to help you and your family cope with stress.

Hospice care is a type of care for people who are nearing the end of their life, typically when they have 6 months or less to live. Hospice focuses on comfort and quality of life rather than trying to cure an illness. Hospice care can be offered at a care location, like a hospital, clinic, or assisted living. Hospice is also available as in-home care.

Example: If someone is very sick with cancer and their doctors say there is no treatment left that could help, they may choose hospice care to receive pain management, comfort, and emotional support at home or in a hospice facility.

Comfort care, also called end-of-life care, focuses on relieving pain and discomfort when someone is nearing the end of their life. In the context of comfort care, physical, emotional and spiritual needs are all given priority.

Example: Comfort care might involve giving someone higher doses of pain medication to ease suffering, even if it might shorten life, because the focus is on comfort rather than prolonging life.

Life-sustaining treatments are medical procedures meant to keep you alive, like Cardiopulmonary Resuscitation (CPR) or a breathing machine. However, when someone is near the end of life, these treatments may only prolong the dying process and may cause discomfort.

Example: If someone has a terminal illness and their heart stops, CPR might be performed to try to restart the heart, but it may not be successful in improving their overall condition.

*Note: Emergency care typically defaults to life-sustaining treatment measures.

Artificial nutrition and hydration are medical treatments used to provide food and water to people who cannot eat or drink on their own.

Example: Someone who is in a coma might be fed through a tube inserted into the stomach or nose. This is different from spoon-feeding someone who can still swallow. Artificial hydration could also involve giving fluids through an intravenous (IV) drip.

CPR is an emergency procedure used when someone’s heart or breathing stops. It includes chest compressions, electrical shock, drugs, and sometimes breathing into the person’s mouth to help restart their heart and breathing.

Example: If someone collapses and stops breathing, CPR may be used to try to revive them. However, CPR is less effective for older adults or people with serious illnesses and is often unsuccessful in those cases (17% success rate in hospitals and 3% in nursing homes). Even after CPR, an individual often is not able to return to their prior level of health.

A “Do Not Resuscitate” (DNR) or “Do Not Attempt Cardiopulmonary Resuscitation” (DNAR) order is a decision to avoid life-saving procedures like Cardiopulmonary Resuscitation (CPR) if your heart stops or you stop breathing.

Example: you have a serious illness and do not want to be revived by CPR if your heart stops, you can complete a CPR Directive with a clinician to prevent that from happening. The goal is to allow a natural death without aggressive, life-prolonging treatments.

A Do Not Intubate (DNI) order means that you do not want to be placed on a ventilator or given a breathing tube if you are unable to breathe on your own.

Example: If you have a terminal illness and want to avoid being placed on a breathing machine, a DNI order would ensure that your doctors do not use a ventilator to try to keep you alive.