Expressing Other Wishes for Your Care

For some people, health care directives—no matter how detailed about things like respirators and surgery—do not reach the heart of their concerns: spiritual matters, money available for care, dying with dignity, quality of life or the well­being of those who care for them.

If you have such concerns, you should discuss them with your health care agent if you have named one—but you can also include them in your written health care instructions. We ask you whether you would like to describe, in your own words, your feelings on any of the following topics:

• the location of your care
• palliative care
• limits or exceptions for pain relief
• personal or religious values, and
• any additional wishes.

This section provides you with a little more information about each option.

When you enter your preferences, state your health care instructions to be confusing to those charged with carrying them out. Be sure that any wishes you specify here do not conflict with other directions you have given.

Location of Care

If where you receive care in the final months, weeks or days of your life is very important to you, you have many ways to set out your wishes. You may state a specific location that you would prefer, such as "at home" or at a particular hospital or hospice facility. Or, you may want to make a more general statement of your preferences, such as any location that lets you be with loved ones at all times.

On the other hand, you may wish to make clear that the location of your care is not as important as getting the treatment you desire. Perhaps you feel that if getting the care you want means being in the intensive care unit of a hospital, you would want to be there. You can state that whatever it takes to prolong your life is more important than where your care is administered.

Location of care may also arise as an issue surrounding diseases such as Alzheimer's or other types of severe dementia. If you have preferences regarding nursing homes or other long-­term care options, you may say so.

When specifying wishes for the location of your care, be mindful of creating possible inconsistencies with other health care instructions you have given. For example, if you've expressed a wish for continuation of life­-prolonging treatments during a terminal illness, and you've also expressed a preference to receive care at home, make clear which factor is more important. That is, are you willing to forgo some care in order to remain at home, or does the availability of life­-sustaining treatment trump your concern about location?

Most important, don't forget to discuss your feelings and wishes with your doctor, your health care agent (if you have named one) and other loved ones.

Palliative Care

Whether or not you want to forgo treatments designed to prolong your life, your health care directive will state that you wish to receive treatment to keep you comfortable and alleviate pain. As discussed above, this type of care is commonly called comfort care or palliative care. Such care attempts not only to provide physical comfort, but also tends to emotional and spiritual needs as well.

If you wish, you can use your document to express any additional or specific wishes you have regarding the way comfort care should be administered. For example, if you prefer a particular course of treatment for pain, including specific medications, you can describe that here.

In addition, you can use this section to describe any wishes or arrangements you have made for hospice or other end­of­life comfort care, and you can set out specific feelings about what would help you remain comfortable at the end of your life. Perhaps you'd like some particular music played or to have favorite stories, poems or passages read aloud during your final days, when you may be too weak to speak for yourself. This kind of wish is appropriate for this section as well as a discussion with your doctor and loved ones.

Pain Relief Exceptions

Unless you specify otherwise, your health care document authorizes your doctors to provide you with as much medication as they deem necessary to keep you pain free. If for any reason you do not want this, you may state your wishes in this section.

For example, if you have concerns about potential opioid addiction or if you are allergic to certain painkillers, you may wish to specify that you do not want those types of pain drugs. Or, you might state that you do not want so much pain medication that it compromises your ability to remain alert and aware of your loved ones.

Of course your doctor may have access to things like bad reactions or addictions through your medical records. But including these preferences in your health care directive puts this information in the hands of your agent, so that your agent can make sure you get the treatment you want.

Personal or Religious Values

At the end of life, health care issues inevitably arise that are not covered by specific directions. When that happens, a statement of your overall philosophy or religious beliefs on matters of medical treatment and dying can help your care providers make decisions on your behalf.

This can be a difficult subject to address, but you may want to consider topics such as:

• your overall goals for your health care
• any fears that you have
• your spiritual or religious beliefs or traditions
• your beliefs about when life would no longer be worth living, and
• your thoughts about how your medical condition may affect your family—personally, practically, financially or

Certainly, you should not feel obligated to write a treatise on these matters in your health care directive. If you have any particularly strong feelings, however, they are worth noting. You should also make a particular point to discuss these issues with your health care agent, if you have named one, and other loved ones.

Any Other Wishes or Statements

Finally, we provide a place where you can write out any other feelings or preferences for your health care. You may use this section to write whatever you like, being careful not to create conflicts with any instructions you've already given. In addition, you will want to be sure you've thoroughly discussed your other wishes with your health care agent or other caretakers.

Learn more about how Pregnancy Could Affect Your Wishes.

You can use DNR and POLSTs to express your wishes for emergency health care.