By Eleanor Tanno, M.D.
Many people want to talk to their doctor about creating an advance directive. This is understandable since the process can seem daunting. For many, discussing their wishes with a trusted, medical professional brings reassurance and comfort.
Your primary care physician (PCP) is a great person to ask questions about your specific medical situation. Depending on your health, an oncologist, cardiologist, or other specialist may also know you well and be willing to have these conversations with you. Just note that most states do not require a physician signature on an advance directive form. In most states, just your signature and a witness is needed. However, your doctor can likely provide you with some helpful guidance.
So how to get started in talking to your doctor about your advance directive?
As with any conversation that is potentially complex and emotional, it helps to prepare. The more you know going in, the more valuable this time will be.
How to Prepare for Your Conversation with Your Doctor:
1. Choosing your Medical Decision Maker
Think about who you would choose as your medical decision maker if you were not able to make your own decisions. This person is known as your medical Power of Attorney (POA). Choosing your medical POA is the first step of any advance directive. Therefore, it is helpful to think of this person prior to meeting with your PCP in case you have any questions about whom to select.
Is the first person who comes to your mind your spouse, an adult child, another family member, or a close friend? About 1 in 5 people do not have an obvious person to choose so if that is your situation, you are not alone and can learn more here.
Is this person likely to be healthy and available for you?
Is this person able to make decisions when under stress?
Is this person able to honor your wishes, even if they differ from their own?
If you have multiple adult children, make sure to either designate one in particular, or know that if you do not specifically name a POA, the legal order of succession is a spouse followed equally by adult children in most states. Read more about pitfalls to avoid when choosing a POA here.
Regardless, I highly recommend discussing your medical wishes with all those who will likely be involved in your medical care, not just the one you legally name as your POA and your back-up POAs. You probably do not want to accidentally cause turmoil in relationships down the road because someone felt excluded or unheard. The Conversation Project has a great guide to help you get started in these conversations with your loved ones.
2. Review your State Advance Directive Form
Each state has their own advance directive form. You can find your state form here from the AARP. There are also advance directive forms that are more universal. The Five Wishes document is legal in 46 states and is very user friendly. The MyDirectives form is free, can be easily completed online, and can be readily available to hospitals in an online database.
Review your state form. Skim it once, then take some time to review it in more detail. These forms can be intimidating because some are full of medical and legal jargon. You do not need to fully understand the form, but it helps to know what you are working with. Generally, all advance directives have two parts: one is naming your medical POA and, two, is defining your medical wishes. More on that next.
3. Think about your Litmus Test
There is one key question to ask yourself to help define your medical wishes. This question is “I would want to be kept alive, as long as at the end, physicians believe I will still be able to ____.” I have coined the answer to this question the Litmus Test.
For some people, the answer to the Litmus Test is being able to live independently, still talk to people, or still participate in a loved hobby.
In other words, given any range of medical scenarios, such as a big stroke, a body-wide infection, or other significant illness, would aggressive medical care likely restore your body to be able to perform a level of function that you still deem to be quality of life and worth living? If yes, continue with the aggressive care. If likely not, you grant permission to your POA to stop that intensive care and focus on quality of life.
You can read more about Litmus Tests here.
In preparation for your doctor’s appointment, knowing who might be your POA, your Litmus Test for your medical wishes, and reviewing your state documents is a fantastic start.
Schedule an appointment with your PCP
Next, schedule an appointment with your PCP. Schedule this appointment specifically to discuss your advance directive so your physician can know when walking into the room what you want to cover. I would not advise trying to cram this discussion into a yearly physical or asking about another health concern in the appointment. The unfortunate reality is that most PCP appointments are only about 15-30 minutes so focusing the discussion to this one topic is best. You can always schedule a follow up visit if you need more time after the first visit.
Attend your appointment.
Come a few minutes early to make sure you are not limiting any of your time.
Start with an open ended statement and let your doctor guide you. “I wanted to discuss my advance directive with you. I plan to name [my spouse] as my medical POA. The most important thing to me is that I am still able to [live independently and have meaningful conversations with my children]. I reviewed my state form. Given my health history, is there anything you think I should consider?”
Some doctors are more comfortable with these conversations than others. However, we generally all know about your specific chronic conditions, and can anticipate possible serious medical scenarios you may one day face.
The goal of the visit is not necessarily to complete the forms that day. The goal is to offer you some aspects you may have not considered. Perhaps there are some thought provoking questions or observations on your health and family dynamics.
After Appointment:
Did you get everything you needed from your doctor? Do you need a second or third appointment after some time to process? Once you feel you are ready, discuss your medical wishes and Litmus Test with your POA. Document your advance directive in either your state form or another advance directive form. Lastly, make copies available to your POA, any loved ones who may be involved in the process, and your doctor. You can upload your advance directive to MyDirectives online too so it is more easily available in a hospital setting.
Want to learn more:
My free step-by-step guide
My online course “Create an Advance Directive with a Physician”
My podcast episode with end-of-life doula Traci Arieli of Comforting Measures