Advance Care Planning: A Gift You Give Before It’s Needed
Imagine this:
You’re in a hospital room. Someone you love is lying unresponsive in bed. Choices for medical interventions need to be made. A clinician asks a question that feels both urgent and impossible:
“What would they want us to do?”
In that moment, love alone doesn’t give you the answer.
Clarity does.
Advance care planning is how we offer that clarity.
It’s the process of thinking ahead, talking with the people who matter most, and documenting your wishes for future health care in case you can’t speak for yourself. Advance care planning is about honoring your values: what matters to you, what you would find acceptable or not, and how you define quality of life.
It’s not just for those older adults near their end of life. It’s for people who suffer accidents, sudden unexpected illness, drug overdose, surgery—any situation where decisions might need to be made quickly and under stress and you aren’t able to speak for yourself.
Two Essential Pieces: Conversation & Documentation
1. Conversation
Honest, detailed conversations with:
- the people you trust most
- your health care providers
These conversations may cover things like:
- how you feel about life-sustaining treatments (such as CPR, ventilators, artificial nutrition); how much are you willing to undergo to sustain life
- what comfort means to you
- what gives meaning to your living
- your definition of independence and how much you are willing to compromise on that
- where you would want to be cared for, if possible
- what you hope for—and what you would want to avoid
- any spiritual or experiential foundations for your thinking
2. Documentation
Putting those wishes in writing so others can act on them confidently.
In New Hampshire, we’re fortunate to have excellent, free resources through the Foundation for Healthy Communities Advance Care Planning initiative. Their site includes clear explanations, guides, and the legal forms you need:
The NH Advance Directive
An Advance Directive is the legal document that captures your wishes for medical treatment if you cannot speak for yourself. Each state has its own. In New Hampshire, the document has two parts: I) who you want to speak for you (“durable power of attorney for health care”) and II) your wishes regarding life-sustaining treatment (“Living Will”).
👉 Download the NH Advance Directive here
- Who Speaks for You
This is your Durable Power of Attorney for Health Care (DPOAH)—also called a health care proxy or agent. Here, we’ll refer to this person as the proxy.
Your proxy is the person you choose to make medical decisions only if you are temporarily or permanently unable to do so yourself.
A good health care proxy is someone who:
- is over 18
- understands and respects your values
- can stay grounded in emotionally charged situations
- is willing to speak up on your behalf
- can set aside their own preferences to honor yours
- is reachable in an emergency
This does not have to be a family member. In fact, sometimes someone outside the family can be better able to stay clear-headed, or help mediate between family members or the medical team.
Before naming your agent, ask if they are willing—and then really talk.
For a light but thoughtful introduction to this choice, see The Conversation Project video Who Will Speak for You? They also offer a helpful Guide to choosing a Healthcare Proxy.
See also Healthcare Proxy Support.
2. Your Living Will
This outlines what you would or would not want if you were facing an advanced, life-limiting, incurable, and progressive condition.
The New Hampshire Living Will is brief and clear. It allows you to indicate whether you would want:
- all possible life-prolonging measures, even if burdensome and despite any costs or complications
or - more limited treatments that offer reasonable hope of benefit
You can (and are encouraged to) add written explanations about what you consider burdensome or beneficial. You may add comments regarding pain, awareness, and measures you would want for comfort. Like wedding vows, sometimes you want to write your own and add them to the traditional ceremony. Here is a sample DementiaDirectiveSupplement.
A widely used reflection tool is The Conversation Project’s What Matters to Me Workbook:
What to Do With Your Completed Advance Directive
Once you’ve completed your Advance Directive:
- Have it witnessed by two independent adults or notarized
(Notarization isn’t required in NH, but it can help with use across state lines.) - Make multiple copies
- Share them with:
- your health care providers
- your usual hospital
- your health care proxy (DPOAH)
- close family members
- your lawyer, if you have one
- Keep a digital copy that’s easy to access
- Do not store it in a safety deposit box – keep it accessible to others if they need to find it.
Some people also choose to make a short video of themselves reading or explaining their wishes. While not a legal document, it can authenticate your wishes and be deeply reassuring to loved ones and guide a medical team in a crisis.
When Does an Advance Directive Take Effect?
As long as you can speak for yourself, you remain in charge of your medical decisions.
Your Advance Directive may be activated by your physician only if:
- you are temporarily unable to speak for yourself (for example, under anesthesia), or
- you are formally determined – typically by your physician or medical team – to lack decision-making capacity
Until then, no one else speaks for you.
Other Forms You May Want to Know About
Advance care planning can also include:
- a HIPAA release (so your proxy can access medical information if needed) Available at your providers’ offices. Remember to include all providers from primary care to specialists and hospital.
- POLST or DNR orders (for specific medical situations) obtained directly through your healthcare provider See POLST/Do Not Resuscitate.
- Dementia and VSED directives Directives for Special Situations
A final thought
Advance care planning isn’t about predicting the future.
It’s about relieving the people you love of guesswork—and making it easier for clinicians to honor who you are.
It’s one of the quietest acts of care, and one of the most generous.