Planning Ahead: Understanding End-of-Life Decisions for Peace of Mind
- Mitzi Krockover, MD
- Apr 30
- 4 min read
Many of us avoid end-of-life planning, yet it's one of the most important conversations we can have with our loved ones and healthcare providers. Creating clear directives about your medical care preferences isn't just for the elderly or ill—it's a thoughtful step anyone can take to ensure their wishes are respected and to relieve loved ones of difficult decisions during emotional times.
Why Advanced Directives Matter
Advanced directives are legal documents that outline your preferences for medical care if you cannot make decisions for yourself. The COVID-19 pandemic highlighted gaps in our preparedness for such medical emergencies. Many families faced heart-wrenching choices without knowing their loved ones' wishes. Dr. Maria T. Carney, Chief and Medical Director of Geriatrics and Palliative Care at Northwell Health and author of The Aging Revolution, notes that these conversations should happen "even when you're well, we should be making those decisions."
Healthcare Proxy: Your Medical Decision-Maker
A healthcare proxy (also called a medical power of attorney in some states) is someone you designate to make healthcare decisions on your behalf if you cannot.
When selecting a healthcare proxy, consider someone who:
Understands your values and wishes
Can make difficult decisions during emotional times
Will advocate for your preferences, even if they disagree personally
Is reasonably available if needed
Dr. Carney shares her personal approach: "For me, I've chosen my husband, but now as I'm getting older, and my children are becoming adults, I'm starting to think maybe I should reevaluate, and maybe I should name one of my children my healthcare proxy in case something happens."
Your healthcare proxy doesn't have to be a family member. When asked if it could be a non-relative, Dr. Carney confirms: "It can." The most important factor is choosing someone you trust to honor your wishes.
What Happens Without a Healthcare Proxy?
When someone doesn't appoint a healthcare proxy, healthcare facilities must follow state-specific laws that establish a decision-making hierarchy. Dr. Carney notes that New York's Family Health Care Decisions Act creates a specific order: guardian first, then spouse, followed by children - without specifying which child should decide if multiple exist and disagree. This lack of clarity can create family tensions during difficult circumstances and might result in treatment decisions that don't reflect the patient's preferences.
Living Wills: Documenting Your Preferences
A living will is another vital component of advanced directives. It details your preferences for medical treatments, particularly life-sustaining measures. Unlike a healthcare proxy, which designates a person, a living will focus on specific treatments.
Dr. Carney explains: "A living will kind of describes what is you want or don't want, and it really helps the healthcare proxy make decisions."
Living wills typically address preferences regarding:
Resuscitation (CPR)
Mechanical ventilation
Tube feeding
Dialysis
Antibiotics and other medications
Comfort care
The Broader Role of Healthcare Proxies
It's important to understand that healthcare proxies make more than just end-of-life decisions. As Dr. Carney points out: "Healthcare proxies not only decide end-of-life issues, they also may decide after hospitalization, do you go home, or do you go to a skilled nursing facility and who helps make those decisions? So a healthcare proxy has a lot more decisions than just end-of-life issues."
Having the Conversation
Once you've designated a healthcare proxy, the next crucial step is openly discussing your wishes. These conversations might feel uncomfortable, but they're invaluable.
Consider discussing:
Your values and what quality of life means to you
Specific medical interventions you would or wouldn't want
Religious or spiritual beliefs that might influence decisions
Where you'd prefer to receive care if possible
Documentation
Your primary care physician is an excellent resource for beginning this process. Dr. Carney confirms: "Your physician is the first one to help. Studies have shown that.. individuals want to speak to their physicians about it."
Some medical offices provide advanced directive forms, though not all do. Dr. Carney mentions that in her practice, "We have healthcare proxy forms... in our health system [we] are trying to promote the use of these advanced directives."
If your provider does not have the necessary forms, other sources include:
1. State health department websites - most states offer downloadable forms online
2. Legal aid organizations or elder law attorneys
3. Organizations like the American Bar Association, AARP, or National Hospice and Palliative Care Organization
4. Online legal document services
If you're looking for state-specific forms, visiting your state's health department website is often the most direct approach. Most allow you to download and print the forms for free.
By taking time to complete advanced directives, you're ensuring your wishes are known and providing an invaluable gift to your loved ones—the peace of mind that comes from knowing they're making the right decisions on your behalf.
To hear more from Dr. Carney about this topic and other issues on aging, listen to her interview on Beyond the Paper Gown HERE.
References
National Institute on Aging. (2023). Advance Care Planning: Healthcare Directives. https://www.nia.nih.gov/health/advance-care-planning-healthcare-directives
American Bar Association. (2022). Consumer's Tool Kit for Health Care Advance Planning. https://www.americanbar.org/groups/law_aging/resources/health_care_decision_making/
Sudore, R.L., et al. (2017). Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel. Journal of Pain and Symptom Management, 53(5), 821-832.
Institute of Medicine. (2015). Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. The National Academies Press.
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