Although discussing death and dying is difficult and sad, it is recommended that a person with advanced cancer revise and review his or her wishes at the end of life with family and health care professionals. An important step for many is to create, or perhaps make changes to, an advance directive.

Advance directives are legal documents that explain the kind of medical treatment you want and do not want if you become unable to make these decisions for yourself. Advance directives communicate your rights and preferences for medical treatment to your family members and other caregivers to avoid confusion later on. You can protect your rights and preferences for medical treatment by writing down your wishes in an advance directive and having a witness or witnesses sign the statement. It is important to talk with your family and doctor about your wishes ahead of time to clarify your decisions and the values underlying them.

Making an advance directive

Any adult who is mentally and physically able to understand his or her medical condition and express preferences about their care can make an advance directive.

In most states, an advanced directive can be oral (spoken), although it is less likely to be challenged if it is in writing. Most, but not all, states honor an advance directive made in other states. If you move to another state, it is a good idea to complete a new advance directive. It is important that you and other people involved in decisions about your health care have accessible copies of your advance directive. Copies should also be given to any institution where you are treated (such as a hospital, doctor's office, or nursing home) and where you live. At this time, there is no advance directive form that is valid in all 50 states. Check your state's requirements and guidelines about advance directive documents.

Types of advance directives

Living will. This is a written set of instructions outlining your wishes about types of medical care you may or may not want in order to sustain life. A living will is also referred to as a Directive to Physicians and Family. It is used in situations when you have a life-limiting illness and can no longer communicate your wishes about medical care. A living will can include statements about:

• Whether you want the medical team to use cardiopulmonary resuscitation (CPR) and/or artificial life support, such as mechanical respirators, if your breathing or heart stops. Learn more about CPR and do not resuscitate (DNR) orders [2].
• Whether you would want to receive a feeding tube (artificial nutrition and hydration), if you cannot be fed otherwise
• Whether you want the doctors to perform certain procedures, such as kidney dialysis

Living wills can be as detailed as needed to make sure that your desires and wishes for life-sustaining treatments are honored. A living will can also include directions about donating organs [3] and tissue.

Durable power of attorney for health care. This type of advance directive designates a person that will make medical decisions for you if you become unable to make them yourself. The person you appoint is often referred to as your health care proxy, agent, or attorney-in-fact. This person has authority only over medical decisions, not other matters, such as finances. Any competent adult, age 18 or older, can be a health care agent.

Your health care agent can make decisions about your medical care after your doctor certifies in writing that you are no longer able to make your own decisions. Once you choose a health care agent, you can still make your own decisions about your medical care; your health care agent will only make decisions once you are unable to do so. It is important to talk with the person you are appointing as your health care agent so that he or she knows your wishes.

Once you make an advance directive, you can change it if needed. Changes are allowed as long as you still have or regain your ability to make decisions. You will need to notify your health care team if you make any changes.

More Information

End-of-Life Care [4]

Advanced Cancer Care Planning [5]

Cancer-Directed Treatments at the End of Life [6]

Additional Resources

Download state-specific advance directive forms [7]

American Cancer Society: The Advance Health Care Directive [8]

National Cancer Institute: Advance Directives [9]