Conversation Resources

Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life

In September 2014, the Institute of Medicine released the report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. The report finds that most people are unable to make their own decisions about care when they’re nearing the end of life. Even if you’re young and healthy, anyone can face a sudden illness or injury. That’s why it’s so important to have a conversation with your loved ones and care providers about your end-of-life goals and preferences now—before a crisis.

This conversation shouldn't be a one-time event. Instead, it should happen at key points throughout your life, as your values, goals for care and preferences change.

It's time to have the conversation...

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Advance care planning can begin at any point in your life, regardless of your current health status, and should be revisited periodically or as your health changes. There is no single form or "best way" to carry out advance care planning. What’s important is that you talk regularly about your goals and values with your loved ones and care providers and take steps to make sure your preferences are known and honored.

Advance Care Planning

Talking about your values and goals for care at the end of life is an important part of advance care planning. Advance care planning should also involve recording your preferences, which could include written documents such as advance directives and medical orders.

Advance directives are documents that help outline future preferences for treatment.

  • Durable power of attorney for health care, also known as a health care proxy, is a document that identifies a health care agent who is authorized to make medical decisions in the event that you cannot make them yourself.
  • A living will is a written (or video) statement about the kinds of medical care you do or do not want under certain specific conditions (often "terminal illness") if you are no longer able to express your wishes.

Medical orders are based on your current health status, values, and goals for care and help ensure that care preferences are honored.

  • Physician or medical orders for life-sustaining treatment (POLST/MOLST) are medical orders covering a range of topics likely to emerge in caring for a patient near the end of life. These orders must be followed by all health care professionals in all care settings, including emergency medical personnel.
  • Do-not-resuscitate (DNR) orders cover specific treatments that are written in a health care facility. These orders do not necessarily cross care settings and may not be honored outside of a health care facility setting.

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