Long-Term Planning and Advance Directives

According to the National Institute on Aging, Advance Care Planning involves learning about the types of decisions that might need to be made, considering those decisions ahead of time, and then letting others know about your preferences, often by putting them into an advance directive.

What is an Advanced Directive?

An advance directive is a legal document that goes into effect only if you are incapacitated and unable to speak for yourself. This could be the result of disease or severe injury—no matter how old you are. It helps others know what type of medical care you want. It also allows you to express your values and desires related to end-of-life care. You might think of an advance directive as a living document—one that you can adjust as your situation changes because of new information or change in your health.

What is the Conversation Project?

As caregivers, you might need to make health care or medical decisions on behalf of your loved ones. It is important for caregivers to know, understand, and be able to carry out their loved ones’ wishes and preferences. Dedicated to helping people talk about their wishes, the Conversation Project offers a Conversation Starter Kit that is easy for a non-clinical person to use. There is no guide or single conversation that can cover all decisions that you and your family may face. However, a conversation like this can provide a shared understanding of what matters most to you and your loved ones, making it easier to make decisions when the time comes.

The Conversation Project Starter Kit (PDF)

What are Advance Directives?

After you and your loved ones have this conversation, it is important to understand what advance directives are available to execute your loved ones’ stated wishes and preferences in the event they are unable to communicate them.

Living Will (Advance Directive for Health Care or Health Care Declaration): A written statement that expresses your loved one’s attitudes, wishes, and preferences about his/her medical treatment. Living Wills guide Health Care Agents and Health Care Teams to make medical treatment decisions accordingly. These wills are generally prepared by attorneys. Please keep in mind that the Commonwealth of Massachusetts does not officially recognize Living Wills.

Massachusetts Health Care Proxy (Durable Power of Attorney for Health Care): A legal document that identifies a Health Care Agent who will make only health care-related decisions in the event that a physician determines that your loved one lacks the capacity to make those decisions. Your loved one should designate a Health Care Agent regardless of his/her age and health status. For more information, visit the Massachusetts Medical Society: Health Care Proxies webpage or download the Massachusetts Healthcare Proxy Form (PDF). You and your loved one also have the option to consult with an attorney to prepare a more personalized, comprehensive Health Care Proxy / Durable Power of Attorney for Health Care document.

Five Wishes: A document that serves as both a Living Will and Health Care Proxy that meets the Commonwealth of Massachusetts’ legal requirements. For more information and the form, visit the Five Wishes website.

Massachusetts Medical Orders for Life Sustaining Treatment (MOLST): This is a medical order form from your loved one’s health care provider to other health care professionals that documents his/her preferences for life-sustaining treatments when he or she is very sick. This medical document is appropriate for loved ones with serious advanced illness and/or medically frail. For more information, visit the Massachusetts Medical Orders for Life-Sustaining Treatment website or download the MOLST form (PDF).

Remember to keep a copy of your loved ones’ advance directives in a safe and accessible place.