Writing down your medical treatment preferences in plain language
The short answer
Start with what matters most to you, then say what you'd want in three situations: when recovery is likely, uncertain, or unlikely. Use your own words, name the outcomes you'd find unacceptable, and say how much say your agent should have. Give the page to your medical power of attorney and your doctor.
Forms ask about ventilators and feeding tubes. Real life asks harder questions. Would you want to go to rehab for three months if you could walk again afterward? Would you want to live in a nursing home if you couldn't recognize your friends?
Advance care planning is the work of answering those questions ahead of time, in your own words. Your formal advance directive handles the legal side. This post is about the page that goes with it in your care plan. It holds plain sentences that tell the people deciding for you what you'd actually want.
Why plain words matter
Forms are built for a few narrow situations. Washington's health care directive, for example, speaks to a terminal condition or a permanent unconscious condition (RCW 70.122.030). Most hard medical weeks are neither.
In those weeks, the person deciding is usually your medical power of attorney. Washington law asks them to decide in good faith what you would choose. Only if they can't tell do they decide on your best interests (RCW 7.70.065).
Your own words are how they tell. And guessing is harder than it sounds. The National Institute on Aging cites a study in which people guessed nearly one in three end-of-life decisions for a loved one incorrectly (NIA).
Start with what matters most
Before any treatment, write a few sentences about your life. These are the answers your agent will lean on when nothing on a form fits.
Some prompts that help:
- What does a good ordinary day look like for you?
- What would you need to be able to do for life to feel worth living? Recognizing people, talking, reading, being at home, being with the dog.
- What worries you most about serious illness? Pain, being a burden, being kept alive by machines, being sent away from home.
- When you've watched someone else go through a hard illness, what did you think, "I'd want that," or "I'd never want that"?
- How do you feel about trying something hard for a chance at more time?
There are no right answers. "I'd put up with a lot to get back to my garden" is as useful as "keep me comfortable and let me go."
Write it as three situations
Most decisions turn on one question: how likely is it that you'll recover? So it helps to write your wishes in three parts.
| If recovery is... | Example of what you might write |
|---|---|
| Likely | "Do everything reasonable. I'm fine with surgery, rehab and a hard few months." |
| Uncertain | "Try it for a set time, then stop if it isn't working. Ask my doctors how long is fair." |
| Unlikely | "Focus on comfort. I don't want to be kept alive by machines if I won't wake up and know people." |
Your own words might be quite different. The point is to give your agent a different answer for each kind of situation, instead of one answer for all of them.
Trying a treatment for a while
Many people like the idea of a trial: start a treatment, then stop if it isn't helping. That's worth saying in writing. Here is one way to say it: "I'd accept a breathing machine for a week or two if I'm likely to come off it."
Outcomes you'd find unacceptable
This is often the most useful sentence on the page. Name the states you would not want to be kept alive in, long term.
- "Not knowing who I am or who my friends are."
- "Needing a machine to breathe, with no chance of coming off it."
- "Being unable to swallow, with no chance of that coming back."
Write what you mean in everyday terms. Your doctors can translate it into medical terms, and your agent can point to it.
Say how much room your agent has
Some people want their written wishes followed to the letter. Others want their agent to weigh the moment and decide. Both are fine, but say which.
- "Follow what I wrote, even if the doctors suggest otherwise."
- "Use what I wrote as a guide, but you'll know more than I can now. I trust your judgment."
- "If my doctors think I have a good chance of recovering, you can override what I wrote about machines."
This gives your agent permission, which is a gift. It's much easier to decide when you know the person you're deciding for wanted you to.
Comfort is always on the table
Saying no to life support is not saying no to care. Washington's definition of life-sustaining treatment leaves out medicine and procedures given only to relieve pain (RCW 70.122.020).
So say what comfort means to you. Do you want pain relief even if it makes you sleepy? Would you want to be at home, with music, with the dog on the bed? Would you like someone to read to you, or to pray with you?
These details are small, and they shape the end more than any machine. Our post on hospice and your wishes covers who speaks for you once hospice begins.
Make it usable, not just written
A page of wishes only helps if it reaches the right people and they understand it. Three habits make the difference.
- Talk it through with your agent. The National Institute on Aging calls conversation the most important part of advance care planning (NIA). Read your page aloud together and ask what's unclear.
- Bring it to your doctor. NIA notes that Medicare pays for advance care planning as part of the annual wellness visit. Your doctor can tell you which decisions your own health makes likely.
- Attach it to the formal documents. Washington's health care directive form lets you add other specific directions (RCW 70.122.030). Your plain-language page can sit right behind it.
If you are already seriously ill, ask your doctor about a POLST too. Our post on POLST vs advance directive explains what it adds.
Keep it current
Wishes change with age and health. Someone at 62 may write "everything possible," and at 82 write something gentler. Both can be right.
NIA suggests reviewing your advance directives at least once a year and after big changes, such as a move or a new diagnosis. Your plain-language page deserves the same look. Date each version, and give your agent the newest one.
A short example
Here is a typical case, a composite. Ruth, 70, is widowed and lives with a spaniel named Pip. Her medical power of attorney is her friend Ann.
Ruth's page says she loves reading, her garden, and being with Pip. She'd accept surgery and months of rehab to get back to those. If doctors think she won't recognize people again, she wants comfort only, at home if possible, with Pip nearby.
She adds one more line: "Ann, you'll know more than I do now. I trust you." After a stroke, Ann reads that page with the neurologist. The decision is still hard, but it's Ruth's, and Ann knows it.
Where this page fits
Your treatment page works with your other documents, not instead of them. The difference between the person who decides and the paper that guides them is explained in health care power of attorney vs living will. Choosing that person well is covered in how to choose a medical power of attorney.
Some people also write a letter of instruction or keep an in case I die binder. Your treatment page can go in either, as long as your agent has a copy.
If the person you'd choose lives far away or is your own age, a professional can be named first or as backup. Kinly members keep this page in their care plan, where the team on call can read it with their agent. Our guide to choosing professional help explains the options.
Common questions
How do I explain which treatments I'd want and refuse?
Start with what matters most to you, then describe your wishes for three situations: recovery likely, uncertain and unlikely. Name the outcomes you would find unacceptable. Use your own words, and give the page to your medical power of attorney and your doctor.
Is a plain-language statement legally binding?
On its own, it's guidance rather than a legal order. But in Washington, anyone deciding for you must first try in good faith to decide as you would, under RCW 7.70.065. Your written words are strong evidence of that. You can also attach them to your health care directive.
What's the difference between this and my advance directive?
Your advance directive is the formal, signed document, and in Washington the directive itself speaks to narrow situations. Your plain-language page explains your values and covers the many situations in between. The two should agree and point to each other.
Can I refuse life support and still get pain medicine?
Yes. Washington's definition of life-sustaining treatment excludes medication and procedures given only to relieve pain. You can decline machines and still ask for full comfort care.
How often should I update my treatment preferences?
At least once a year, and after a move, a new diagnosis or a change in who you've named. The National Institute on Aging suggests the same rhythm for advance directives. Date each version and give the latest to your agent.
Sources
- Advance Care Planning: Advance Directives for Health Care (National Institute on Aging)
- RCW 7.70.065: Persons authorized to consent for patients without capacity (Washington State Legislature)
- RCW 70.122.020: Natural Death Act definitions (Washington State Legislature)
- RCW 70.122.030: Health care directive (Washington State Legislature)
This page is general information, not legal or financial advice. Laws vary by state.