Advance Care Planning is a process of clarifying your values and health care choices for use at a future time if you are no longer able to make decisions for yourself.
How do I get started with Advance Care Planning?
- Think about the types of medical treatments you would choose to have, or refuse, if you were ill or injured and could not make those choices for yourself. This two page handout provides information on Advance Care Planning and has a Values Worksheet on the back.
Or, visit PREPARE, an interactive online program that can help you identify what is important to you in life. It also covers how to make medical decisions for yourself and others, how to talk with your health care providers and how to get the medical care that is right for you.
- Choose your Health Care Agent and talk with them about your values and choices. For help in talking with your family, visit the Conversation Project which helps you prepare for advance care planning talks, offers helpful tips for starting a discussion, and provides a range of topics for you to think about.
- Complete a VA Advance Directive.
You can also visit www.Ethics.va.gov for additional health care ethics resources for Veterans, patients and family members.
An Advance Directive is a legal form that helps your doctors and loved ones understand your wishes about medical and mental health care. It can help them make decisions about your health care if you are not able to make decisions for yourself. An Advance Directive is the best way to ensure that your future medical care reflects your wishes.
The VA Advance Directive includes sections that allow you to identify a Health Care Agent and to specify your treatment preferences.
Those sections are:
- Durable Power of Attorney for Health Care – This allows you to identify a Health Care Agent, the person who would make health care decisions for you if you are unable to make decisions for yourself. Choose someone you trust and who knows you well.
- Living Will – This allows you to identify the treatments you would and would not want, such as resuscitation, mechanical ventilation (breathing machine) and feeding tube.
The VA honors all types of legal Advance Directives, including forms from another state, Department of Defense or VA. The VA form contains more detail than most other forms and allows you the option to attach additional documents.
Here are two helpful informational documents:
What if I do NOT use an Advance Directive form to choose a Health Care Agent?
If you do not use an Advance Directive form to choose a health care agent, then your VA health care provider will choose a spokesperson to make decisions for you in this order: legal guardian, spouse, adult child, parent, sibling, grandparent, grandchild, or close friend. If the health care provider cannot find anyone from this list, VA staff or a court will make decisions for you.
Podcasts on Advance Care Planning
What's an Advance Directive, and why should I complete one?
Why it's a good idea to fill out an advance directive, and what you might want to think about before you do.
Choosing A Health Care Agent (5:36)
What makes a good health care agent, and some questions to ask before choosing one.
I’ve Been Chosen as A Health Care Agent - Now What? (4:50)
How to fulfill the role of health care agent, and some decisions you might have to make.
Ask your social worker for a VA Advance Directive form or go to www.va.gov/vaforms for the form and related information.
You can also talk with your social worker if you need help starting a conversation with loved ones about your wishes or completing the Advance Directive.
What do I do with my Advance Directive after I complete it?
- Put the original in a safe and easy-to-access place.
- Give copies to your health care provider, Health Care Agent and a family member.
- Put a note on the copies about where the original is kept.
If you have questions about other types of Advance Care Planning talk with your primary care provider. If you are dealing with a life threatening illness or condition you may want to know more about some of the options below:
Do Not Resuscitate (DNR)
A Do Not Resuscitate (DNR) order is a medical order indicating that you do not want to have cardiopulmonary resuscitation (CPR) if your heart stops beating. Unless given other instructions, hospital staff will use CPR if a person’s heart stops. Talk to your provider about whether CPR is likely to help you reach your health care goals. If you decide you don’t want CPR, you can ask your doctor to write a DNR order in your medical chart. This will tell the health care team not to use CPR if your heart stops beating.
State-Authorized Portable Orders
(POLST — Physician Orders for Life-Sustaining Treatment)
(MOLST — Medical Orders for Life-Sustaining Treatment)
Portable orders about life-sustaining treatment were created by individual states so that people facing life-threatening illnesses or life-limiting conditions could make sure that in a medical emergency health care providers would know and follow their treatment orders no matter where the emergency happens. These orders are often documented on a brightly colored form that you keep on your refrigerator or on a bracelet or necklace that you wear. They are filled out by your health care provider based on talking with you about your preferences. SAPO – State Authorized Portable Orders – are a new type of POLST/ MOLST that is valid outside of VA.
Help with Setting Health Care Goals
This booklet Setting Health Care Goals - A Guide for People with Health Problems covers topics such as the goals of care, who should be part of the discussion, and what are life sustaining treatments.
Organ and Tissue Donation
Some people choose to be an organ donor. To be an organ or tissue donor, you can sign up when you get your driver’s license or in your state's donor registry. If you have preferences about organ or tissue donation, tell your health care agent, loved ones and health care provider.
For More Information
For more information see the Life-Sustaining Treatment Decisions Initiative webpage. (Note - this is an internal VA link, only accessible from the VA network.)
Podcasts on Advance Care Planning
Setting Health Care Goals When You're Seriously Ill (5:56)
How to make sure you get the health care that’s right for you when you are dealing with a serious health problem.