How tragic that Terri Schiavo never discussed her wishes about end-of-life treatment with all her loved ones and completed advance directives.” “I would never want to live like that.” “I still haven’t completed my advance directives.” “Who should I choose to speak for me who really understands my values and wishes and will stand up for me?”

I encourage you to engage in a thoughtful process called advance care planning (ACP) or preparing for the end of your life. It will enable you to prepare for a “good death,” one that is as comfortable as possible and determined by your values and wishes.

It will also spare your loved ones from having to make difficult decisions for you.

First, take some quiet time to think about your own death. What comes up for you?  This time of pondering may evoke fears of pain or discomfort at the end. It may bring up unfinished business, such as unresolved relationships or questions about your relationship with God or your inner source of strength. It may bring questions about your current priorities in life and some things you want to do before your die.  The hardest part of this contemplation is to realize that death can come at any time without warning.

Secondly, take your own health seriously. How much do you know about and take responsibility for your own health, chronic illnesses, such as hypertension, and death predictors based on your lifestyle (being overweight or sedentary, smoking, chronic stress), your family history (heart disease, high cholesterol, diabetes, dementia)? Make an appointment to see your primary provider, not only for a check-up, but also to discuss your life expectancy based on your risk factors, and what treatment issues will probably arise for you in the future. Ask if your practitioner will advocate for you in getting your wishes honored and providing comfort care, including referring you to hospice. 

Thirdly, take some time to think about what you want when your time to die comes, in terms of imagining your ideal death.  Think not only about what you do not want (a ventilator or a feeding tube perhaps), but also about what you do want, such as being at home with loved ones around. What comfort measures do you want, such as having your pet close by, or getting healing touch as your favorite music plays, or having  someone reading sacred writings?

There are some tools and resources to help you with the details of this process and the decisions that need to be made. The University of North Carolina Program on Aging created an interactive, educational website to guide health care students and professionals as well as consumers through the advance care planning process. Among the resources, you can find printable advance directive forms (for North Carolina), the living will and Health Care Power of Attorney (HCPOA) as well as a helpful Advance Care Planning Worksheet you can attach to your forms. The learning module includes a discussion of various treatment options, choosing the best health care power of attorney, and suggestions for structuring a family meeting. In North Carolina, you may also obtain and register your advance directives on line at with the Secretary of State. Five Wishes, another popular tool, is available for purchase. Project Compassion is a local area resource for helping individuals and their families with end of life issues. See 

Fourthly, talk with your family about your wishes. Hear their reactions and invite them to share their own thoughts about their deaths. This can be a challenging and helpful opportunity to resolve any family conflict about carrying out your decisions, so that your death can be peaceful and they will be left with good memories.

Fifthly, print out advance directive forms or obtain them from your local hospital.  Complete them and take them to your bank for signing, witnessing, and notarization.  Immediately make copies of ADs and other documents and distribute them to your agent (HCPOA), your loved ones, your primary provider, and your hospital medical records department.

There are two important details:  Your advance directives must be translated into medical orders to direct your care. This means a physician or authorized nurse practitioner must write orders, such as Do Not Resuscitate (DNR), Do not tube feed, Do not hospitalize, etc., if and when you become terminally ill or in a persistent vegetative state.  You also need an accompanying portable yellow DNR order, available through your primary provider or hospital, if you are transported anywhere. 

The final step in the advance care planning process is leaving your legacy. Legacies may include completing an organ and tissue donor form available on the Secretary of State website, or leaving money to a favorite cause or educational institution. It may be writing about your childhood or selecting special personal mementos to give to loved ones now. The best legacy may be to be a role model of living your life to the fullest, recognizing how precious life is and bringing joy to others and yourself.