Checklist Item #2 is not #2 for the reason you think it is.

For those who have forgotten, Item #2 on Our Fourth Age Checklist of “Things To Do Immediately” is to undertake Advance Healthcare Planning.

You might be thinking, “An Advance Directive is very important if the state of my health doesn’t allow me to speak for myself during a medical crisis.” If you are thinking this, it is clearly a great reason for Advance Healthcare Planning to be Item #2 our Checklist. (It’s a close second to Item #1: Pursue a Healthy Lifestyle to help postpone or avoid a medical crisis when #2 might come into play!)

We cannot think of any more dire situation than a possible
life-threatening medical crisis that should incentivize you to undertake Advance Healthcare Planning. However, your potential incapacity during a medical crisis is not the reason why we list it as Item #2.

The reason Advance Healthcare Planning is Item #2 on your list of “Things To Do Immediately” is because of the people you will be leaving behind.

The end result of Advance Care Planning should be your appointment of a Healthcare Representative. What are you asking of this person complying with your Advance Directive when you cannot speak for yourself? You are asking him or her to give instructions to medical staff that will end your life by stopping all extraordinary treatment—even though the instructions are an affirmation of medical diagnosis and expert opinion.  Surely you appreciate how difficult that will be, particularly when your Healthcare Representative is likely a spouse, partner, or sibling, someone who loves you dearly and is already grieving. Knowing that his or her actions are consistent with your personal wishes—that it is your decision to stop treatment, not his or hers—is immensely comforting to your Healthcare Representative in that moment (and afterwards).

In crisis, your family should not be arguing over what is best for you. Let your family and friends attend to their pain, heal hurt or broken relationships, care for your spiritual needs and ultimately say goodbye. An Advance Directive is one of the last expressions of love you make for your family.  

Who among your family, friends, and your doctors clearly understands your values, beliefs and end-of-life preferences? No one will if you don’t have a conversation with them about what makes life worth living for you—physically, emotionally, spiritually and intellectually.

Advance Healthcare Planning should not be a casual process. Do you understand key medical procedures and programs that may be appropriate during the course of a serious illness or at the end of life? Read up about options. Talk to your doctor and get his or her recommendations. Discuss your decisions with your family and especially, your Healthcare Representative! Conversations about your options for care that matter to you—and putting your decisions in writing—are as important to peace of mind for your family and friends as to you. (And review your decisions if your medical situation changes.)

Advance Healthcare Planning is about how you choose to live your life—right up to the end.


Advance Care Planning takes many forms: Directive, Powers of Attorney, Living Wills, POLST (physician orders for life-sustaining treatment) and DNR (do not resuscitate). As long as you are able to make and communicate decisions, your spoken words override anything you have written.

One or more Advance Care Planning forms will be appropriate for your current healthcare situation. Completing any of these forms does not mean you give up control over your medical treatment. In fact you will gain a degree of control over your healthcare by choosing the person who will make medical decisions for you when you cannot.

What if you are experiencing a medical crisis in which you do not have an Advance Healthcare Directive? It can vary state to state, but in Oregon, the following individuals have priority for health care decision-making: legal guardian, spouse, majority of adult children, and then close friends.  Family members are considered to be in the best

position to know what treatment decisions the patient himself would make if competent—and they are usually available in a crisis.

Relying on the “default” of family members making your health care decisions versus appointing a Healthcare Representative is not without some problems:

  • As we commented earlier, family members may not know your wishes regarding your health care;
  • Conflicts among family members are possible;
  • The most knowledgeable decision maker may not be a member of your family; and
  • Family members can make decisions based upon ignorance, a desire to end family distress, or in bad faith and with ill motive.

All of the above are reasons enough for you to have an Advance Healthcare Directive: your wishes are known, and decisions are made by someone who has your best interests at heart.

Where should you keep your Advance Healthcare Directive? Many people understandably want to keep their living will and health care power of attorney forms in a secure place. But if these documents are locked away in a safe deposit box, they won’t be much help if you’re unexpectedly hospitalized. Here are some people who should have copies of your Advance Directive and some other places where they should be filed.

  • First, your doctor.A copy of your advance directives should be in your file and medical record.
  • Second, give it to your Healthcare Representative and any alternative agents.All should have a copy of your health care power of attorney (and your living will, if you have one). In an emergency, your agent may need to fax the documents to doctors or a hospital.
  • Third, have it in your hospital chart.If you are in the hospital, ask to have a copy of your Advance Directive put in your chart. (Your health care agent or a family member should do so if you are unable to do it.)
  • Fourth, put it in a safe spot in your home.File the original documents in a secure place in your home — and tell your agent, family, and friends where you put them. Hospitals may request an original, so it’s important that someone can find the documents when necessary. The National Hospice and Palliative Care Organization suggests noting on all copies of the documents where the originals are stored.
  • Fifth, upload the directive into an “electronic vault”. Keep it online where it can be accessible from any place in the world. NWCM has its Big Picture Study® vault that is perfect for such a purpose.
  • And lastly, carry it with you.Put a card with your health care agent’s name and contact information in your wallet or purse. Also note on the card where you keep the original and additional copies of your directive.

Complete an Advance Directive today!  One is available from your doctor and attorney, or state-specific forms can be downloaded from the Internet:

An Advance Directive is only one very small piece of your estate planning. Often it will be your estate attorney who facilitates completion of this document. One of the “immediate” things to do on Our Fourth Age Checklist is to make an appointment with your professional advisors—and that includes your estate planning attorney.  Pick up the phone and call him or her.  Or call us for some recommendations of good attorneys.


At the homepage of, click on the icon that is 1: Immediate Attention and read the list of priority action items.

Then click on 3: Healthcare Legal Forms for a list of resources.


ML had been ill for years with a condition that, with treatment, was not considered life ending (just debilitating).  However, her medications compromised internal organs which proved fatal. Despite being relatively young, and perhaps sensing the inevitable, she completed an Advance Directive.

As she lay in the hospital on life support with no high-functioning brain activity (and no chance of recovery), I had to tell our children—one still a teenager—that life support would be removed from their Mom.  Would they think Dad was killing their Mom? I explained that this was the wish of their mother, that she had told her doctors and me in writing that she didn’t want to be kept alive like this.  My job was to make sure that the medical assessments were conclusive, and that her condition was hopeless.  Their mother had instructed me how to act.

It was the greatest comfort to me in that moment that I would be acting as ML had instructed. I don’t know how I could have gotten through that conversation with our children otherwise, or carry on each day since, given what I had to do.

That Healthcare Directive was indeed ML’s last expression of love for me and for our children.