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JAMA Internal Medicine Patient Page
November 4, 2019

Advanced Care Planning—What Should I Know?

Author Affiliations
  • 1Division of Internal Medicine, Department of Medicine, University of California, San Francisco
  • 2Editorial Fellow, JAMA Internal Medicine
JAMA Intern Med. Published online November 4, 2019. doi:https://doi.org/10.1001/jamainternmed.2019.0005
What Is Advanced Care Planning?

Advanced care planning involves communicating your values, goals, and preferences about what kind of medical care you would like to receive if you become ill. When you are seriously ill, you may not be able to make decisions about medical care. Other people sometimes need to make these decisions for you. These decisions can be preferences about the types, location, or intensity of treatment that you would want to receive. Talking with your loved ones about your values and wishes, and documenting them in an advanced directive will provide others with guidance to make the best decision for you.

A good place to start the conversation is to describe what in life is most important to you. For some people, this is being physically able to do things that they enjoy. For others, this is being mentally alert enough to spend time with family. Although this may feel uncomfortable, many family and friends say they wish their loved ones had spoken with them earlier about their wishes.

Who Will Make Medical Decisions for Me if I Am Too Sick?

The best way to make sure that you receive the type of medical care that is in agreement with your values is to complete an advanced directive. An advanced directive is a document that contains your preferences about medical treatment. Physicians will use this to guide the type and intensity of treatments that they offer. Advanced directives often include preferences about things including cardiopulmonary resuscitation, life support, and artificial nutrition. In an advanced directive, you will identify a medical decision maker. This should be a family member or friend who knows you and your values and wishes well. Your physicians may contact your medical decision maker with questions about the types of medical treatment that you would want to receive if you are too ill to express your own wishes.

If I Am in Good Health, Do I Need an Advanced Directive?

It is recommended that everyone create an advanced directive and choose a designated medical decision maker in case of an emergency. The best time to make an advanced directive is when you are in good health and fully able to express your wishes.

How Do I Make an Advanced Directive?

Your primary care physician can help provide you with guidance and resources to prepare your advanced directive. There are many internet-based resources that make it easier to prepare your advanced directive. A good place to start is the PREPARE For Your Care website. Discussing your preferences with your loved ones and your physician is an important part of the process. In addition to an advanced directive, consider completing a provider order for life-sustaining treatment (also called a medical order for life-sustaining treatment, physician order for scope of treatment, or medical order for scope of treatment) form. This document provides instructions to emergency medical workers in the event of a serious medical event.

Can I Change My Advanced Directive?

If you are of sound mind, you can change your advanced care planning documents at any time.

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For More Information

Section Editor: Michael Incze, MD, MSEd.
The JAMA Internal Medicine Patient Page is a public service of JAMA Internal Medicine. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA Internal Medicine suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, email reprints@jamanetwork.com.
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Article Information

Published Online: November 4, 2019. doi:10.1001/jamainternmed.2019.0005

Conflict of Interest Disclosures: None reported.

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