Why Conversations Come Before Forms
When people hear “advance care planning,” their minds often jump straight to paperwork: living wills, advance directives, healthcare proxies, or DNR orders. But here’s the truth: forms without conversations fall flat.
Research shows that most families never discuss end-of-life wishes until a crisis. The result? Confusion, conflict, and care decisions that may not reflect what the person actually wanted. At Empowered Endings Foundation, we encourage a different approach: talk first, then forms.
This blog introduces a 90-minute family discussion designed to help you:
- Understand the importance of having an advance directive
- Use an advanced care planning checklist to prepare for forms
- Create a values-first statement to guide tough choices
- Clarify confusing terms like POLST vs DNR
- Start the healthcare proxy conversation with confidence
Think of it as a crash course in peace of mind—for you and the people you love.
Step 1: Set the Stage for a Family Discussion
Before you ever open a form, schedule a family discussion. This doesn’t require a conference room—it can happen around the kitchen table, over Zoom, or during a Sunday dinner.
Here’s a simple agenda to keep the session on track:
- Opening (10 minutes): Ground rules—respect, no interruptions, focus on values.
- Values Discussion (20 minutes): What matters most? Comfort, dignity, staying home, spiritual traditions, minimizing hospital time?
- Advance Care Basics (30 minutes): Go through living wills, advance directives, and proxies together. Use examples.
- Document Prep (20 minutes): Start filling out forms with notes; finish later if needed.
- Closing (10 minutes): Summarize decisions, assign tasks, and schedule follow-up.
With 90 minutes of intentional time, you’ll cover more ground than most families do in years.
Step 2: Living Will vs Advance Directive (What’s the Difference?)
One of the most common questions we get asked is “living will vs advance directive.”
But the real question is, what is the importance of having an advance directive?
Here’s the breakdown families need:
- Living Will: A written document that outlines specific medical treatments you would or would not want at the end of life (ventilators, feeding tubes, resuscitation).
- Advance Directive: A broader legal document that includes both a living will and the appointment of a healthcare proxy (someone who makes decisions if you cannot).
Put simply: A living will is the what. An advance directive is the what + who.
But an advance directive identifies both a living will and a medical durable power of attorney (healthcare proxy).
With that said, if you create a comprehensive Advance Directive, one that clearly documents your healthcare proxy, preferences for medical treatments, and other essential details, it becomes a powerful tool for ensuring your wishes are understood and honored. A complete directive not only supports coordinated, compassionate care but also gives your loved ones and care team the confidence to act in alignment with your values, even when you can’t speak for yourself.
For reference: National Institute on Aging – Advanced Care Planning.
Step 3: Use the Advance Care Planning Checklist
To keep your discussion organized, use this checklist as your guide. It’s designed to prevent overwhelm and ensure every important consideration is covered—so nothing is missed in creating an Empowered End of Life Experience™.
Advance Care Planning Checklist
- Choose Your Healthcare Proxy (POA)
- Identify a trusted person (or alternate) to serve as your healthcare agent or durable power of attorney for healthcare.
- Discuss your values, wishes, and priorities with them in detail.
- Make sure they are comfortable advocating for you if you cannot speak for yourself.
- Clarify Your Medical Treatment Preferences
- Decide on life-sustaining treatments such as ventilation, feeding tubes, CPR, dialysis, or IV hydration.
- Consider when you would want comfort-focused care versus curative treatment.
- Explore your preferences around end-of-life options, including Medical Aid in Dying (MAiD) and Voluntarily Stopping Eating and Drinking (VSED) where legally available.
- Define Your Quality of Life and Values
- Write a values statement to reflect what matters most to you (see Step 4).
- Consider what “quality of life” means to you—what makes life meaningful, and what would make it feel complete.
- Include your emotional, social, and spiritual needs.
- Plan for Comfort, Pain Management, and Spiritual Care
- Identify your comfort measures and pain management preferences.
- Consider who you want present at the end of life—family, faith leaders, or specific companions.
- Include guidance for emotional and spiritual support.
- Discuss Preferred Place of Care
- Decide where you’d prefer to receive care: home, hospice, hospital, or another setting.
- Clarify who you’d like to be present and how you’d like your surroundings to feel.
- Understand POLST vs. DNR (See Step 5)
- Learn the difference between Physician Orders for Life-Sustaining Treatment (POLST) and Do Not Resuscitate (DNR) forms.
- Remember: These forms are completed by a medical provider and signed by a physician.
- Your role is to communicate your decisions clearly so your provider can prepare the appropriate documentation.
- Address Cognitive and Dementia Planning
- Document your wishes in case of cognitive decline, including how you’d like decisions to be made and by whom.
- Consider future support for memory care or long-term care needs.
- Outline After-Death Care Preferences
- Indicate your preferences for organ or tissue donation, autopsy, burial, cremation, or memorial services.
- Include any cultural, spiritual, or family traditions important to you.
- Gather and Complete State-Specific Forms
- Locate official Advance Directive and POLST forms for your state (many are available online).
- Complete all required sections, and have forms witnessed or notarized if necessary.
- Use the Empowered Endings™ Planning Platform, powered by Thanacare, to store these documents digitally and link them via QR code for accessibility anywhere.
- Store and Share Your Plan
- Keep physical copies in an accessible place (e.g., on your refrigerator, in your medical file, or near your bedside).
- Share copies with your healthcare proxy, family, primary care physician, and specialists.
- Upload your plan, videos, and values statement securely in the Empowered Endings™ Planning Platform.
- Review and Update Regularly
- Revisit your plan at least once a year or after any major life or health changes.
- Update documents to reflect new wishes or changes in your healthcare proxy.
- Communicate any updates to your care team and loved ones.
This checklist can also double as a lead-gen PDF download on your site, helping families while building your mailing list.
But keep in mind that these considerations should be discussed with a provider or end-of-life professional, not just family. Consider reaching out to doulas, social workers, and relevant care partners with questions if you’re unclear.
This checklist is a guide but does not replace comprehensive support.
Step 4: Write a Values Statement Together
Forms are important, but they can’t capture everything. That’s why a values statement is essential. It acts as a compass when medical decisions aren’t black and white.
Example template:
“In making medical decisions, I prioritize comfort and dignity over extending life at any cost. I prefer to receive care at home whenever possible. Spiritual rituals are important to me, and I would like them honored. If I cannot speak for myself, my proxy should make decisions that reflect these values.”
Encourage each family member to create their own version. Sharing them aloud builds trust and reduces conflict later.
Step 5: POLST vs DNR (What’s the Difference?)
Two terms that create confusion—and often anxiety—are POLST and DNR. Families frequently ask: Do we need both?
- POLST (Physician Orders for Life-Sustaining Treatment): A medical order completed by a doctor. It covers specific interventions (CPR, intubation, feeding tubes) and is meant for people with serious illness.
- DNR (Do Not Resuscitate): A directive that states you do not want CPR if your heart stops.
Think of it this way:
- A DNR says “no CPR.”
- A POLST is broader, covering a range of treatments and signed by a physician.
It’s also important to know that you can’t fill out a POLST or DNR form on your own—these must be provided and signed by your healthcare provider. What you can do right now is talk with your family, caregivers, or doctor about your preferences. Once these decisions are made and the forms are completed, keep them somewhere easily visible, such as on your refrigerator or bedside table, so emergency responders can find them quickly.
Not everyone needs a POLST—these forms are typically for individuals who are seriously ill or medically fragile. However, everyone benefits from having conversations about their wishes early.
For more info, see National POLST.
Step 6: The Healthcare Proxy Conversation
Choosing a healthcare proxy is one of the most important—and often overlooked—steps. This person will make decisions if you can’t.
Here are scripts to start the conversation:
- “I trust you, and I’d like to name you as my healthcare proxy. This means if I can’t speak for myself, you’ll speak for me. Would you be comfortable with that?”
- “Being my proxy doesn’t mean deciding for me—it means carrying out my wishes. I’ll write them down so you’re never alone in guessing.”
Once chosen, make sure your proxy knows where to find your forms and values statement.
Make it real in the system.
Documents only help if the right people can find them fast. After your 90-minute discussion, upload your advance directive to your patient portal, give printed copies to your healthcare proxy, primary care doctor, and key specialists, and store a copy somewhere obvious at home (many EMS teams still look for a “refrigerator file” or wallet card). If your state offers a registry, file it there, too. If you’re using a digital platform (like our partners at Thanacare), share access with your proxy so updates sync automatically. A quick email to your care team—“Here are my updated directives and values statement for the chart”—closes the loop.
FAQs: Advance Care Planning
What’s the difference between a living will and an advance directive?
A living will lists treatments you do or don’t want. An advance directive includes both a living will and the appointment of a medical durable power of attorney, also known as a healthcare agent or healthcare proxy.
Do I need both a POLST and a DNR?
Not always. POLST is broader and physician-signed. DNR is specific to CPR. Talk with your doctor about what’s best for your condition. They will provide the appropriate documents and encourage you to keep them in an accessible/visible location.
How do I create an advance directive?
You can start with your state’s form (often free online) or work with an attorney or end-of-life expert (End of Life Doula, etc.) to help you create a more comprehensive version and complete the form with witnesses or a notary as required.
Who should I choose as my healthcare proxy?
Pick someone you trust to honor your values, even under pressure. Ideally, someone comfortable speaking up in medical settings.
Revisit on the “5 Ds.”
Advance care planning isn’t one-and-done; it’s living guidance. Recheck your advance care planning checklist at each of the “5 Ds”: Decade (every 10 years), Death (after a loved one dies), Divorce (or major relationship change), Diagnosis (of a serious condition), or Decline (notable change in health). Each time, confirm your healthcare proxy conversation still reflects your wishes, and that choices like POLST vs DNR and treatment preferences match your current values. This rhythm keeps your plan aligned with your life—so when it’s needed, it’s trusted and actionable.
Why 90 Minutes Changes Everything
Advance care planning doesn’t have to take weeks or involve lawyers at every step. A 90-minute family discussion can spark clarity, ease conflict, and ensure wishes are honored.
Talk first, then forms. That simple shift ensures your documents reflect values—not just checkboxes.
CTA: End-of-Life Planning Certification
If you’re a professional who wants to guide families through these conversations, our End-of-Life Planning Certification provides tools, templates, and training to lead values-first discussions with confidence.
References
- National Institute on Aging – Advance Care Planning: Healthcare Directives
https://www.nia.nih.gov/health/advance-care-planning
National POLST – Honoring Choices Across Settings
https://polst.org/
