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April 01, 2015

Six Key Steps of Advance Care Planning

Charlie Sabatino

(The pdf for the issue in which this article appears is available for download: (Bifocal, Vol. 36, Issue 4).)


Step 1. Ask yourself this question: “What are your most important values and priorities in connection with decisions about serious life-limiting health conditions?”

  • Priorities, values, and goals of care change at different life stages. A healthy 18 year old may not have strong preferences, but every decade of life brings experiences such as the deaths of loved ones or friends, or personal health issues. As values and preferences change through every age in life, planning is important for every age, too.
  • Use workbooks to help you explore your values more clearly. See the Resources List.
  • Talking with others not only helps, it’s critical. See Step 3 below.


Step 2. Decide whom you want to make health decisions for you if you can’t.

  • This is not always an easy question to answer. Sometimes the person closest to you may have the hardest time making decisions in the way you would want.
  • Unless you give the legal authority to someone, you leave yourself open to the kind of dispute that propelled the controversial Terri Schiavo case through the courts. You may be setting up loved ones to fight over who is the appropriate decision-maker.


Step 3. Talk, talk, talk with your family, key friends, and health care providers.

  • In addition to talking with the person you want to act as your health care agent, talking with other close family, friends, and physicians is essential to enable them to understand your health-care priorities. If they are not at least minimally aware of your wishes ahead of time, they can create problems for your health-care agent, even though your health care agent has legal authority.
  • Don’t rely solely on written documents because they can generate as many questions as answers.


Step 4. Put it in writing – in a Health Care Advance Directive.

  • A health-care power of attorney is needed to give someone authority to speak for you when you can’t. Every state has standardized legal forms for this, and these are very generally fine to use. A living will or medical directive form provides guidance about your beliefs and preferences, they may or may not be ideal, because they use standardized language that may not adequately reflect your unique priorities and values. Most often, these two types of forms are combined into a single advance document, but they do not need to be combined. See the Resources List.
  • When faced with serious, progressive illness, ask your health care professionals whether POLST is appropriate for you (Provider Orders for Scope of Treatment -- also called MOLST, POST, POST, or by other names). The POLST Program is a clinical process designed to facilitate communication between health care professionals and you to ensure that critical care medical decisions are informed and consistent with your values, goals of care, and preferences. The product is a set of portable medical orders that addresses the use of cardiopulmonary resuscitation (CPR) and other medical interventions and is applicable across health-care settings.


Step 5. Make sure your advance directive is in the right place at the right time.

  • Give a copy to your health-care agent, your doctor, and hospital, clinic, or managed-care plan.
  • A few states have state advance directive registries that will maintain an electronic copy of your form and make it available to certain health care providers when needed. There are also private national registries available that provide a similar service.
  • Download the ABA My Health Care Wishes app ( to your smartphone and the smartphones of your loved ones. That way, you can all store each other’s advance care planning documents on your phone, along with any other medical information you want to include, and have them available to read or to send instantly by email, fax, or Bluetooth to wherever needed.


Step 6. Review your plans when any of the “5 Ds” occur:

  1. Every new Decade of your life
  2. After the Death of a loved one
  3. After a Divorce
  4. After any significant Diagnosis
  5. After any significant Decline in functioning


Interested in more resources?

Check out the Commission's Health Care Decision-Making Resources page, which hosts materials for you and for your clients. An updated version of our Health Decisions Resources (March ’15) is now available. ■

Charlie Sabatino

Charles Sabatino is the Director of the ABA Commission on Law and Aging in Washington, DC.