Advance Directives: Express Your End of Life Care Wishes

Advance Directives: Express Your End of Life Care Wishes

By: Silvia Perez-Protto, MD, MS • Posted on January 08, 2019

What Is Advance Directives?

Advance Directives are legal documents that provide instructions about your healthcare wishes, in case you are unable to speak for yourself.

There are two different types of Advance Directives:

  1. Health Care Power of Attorney
  2. Living Will

Only one third of American adults have Advance Directives (AD). You may believe AD are only necessary when a person is at the end of life. However, they are always helpful when a person becomes unable to make health care decisions.

For example, you or your loved one may become incapacitated to make decisions during surgery under anesthesia. Any healthy person may become suddenly, seriously ill after a:

This is the reason why the Cleveland Clinic and many other organizations recommend that everyone over the age of 18 should make sure their wishes are known and documented.

You have the right to direct your own medical care based on your personal values and beliefs. The Cleveland Clinic recommends taking these three steps:

1. Complete Advance Directives Documents

AD are legal documents per state law, including health care power of attorney and living will. A health care power of attorney names a person who will make medical decisions for you when you can’t speak for yourself.

  • This person could be anyone you trust, usually a spouse, family member or close friend.
  • You can also name alternates in this document.
  • The medical decision collaborator’s responsibility ends when you recover enough to make your own medical decisions again.

A living will explains the care you want if you can’t speak for yourself and you are either terminally ill or permanently unconscious – like if you want or don’t want a breathing machine or feeding tube to keep you alive. Or if you want to have cardiac resuscitation.

The recommendation is to review the documents and revise them as needed every 10 years or whenever you go through an important life event, such as a new health diagnosis, a death in the family, a divorce or upon your child becoming a legal adult at age 18.

2. Talk To Your Loved Ones About Your Wishes

Have the conversation with your loved ones, especially with the person you appointed as your agent. Give a copy of the advance directives to your family members and loved ones so they can follow your wishes. This can reduce anguish, uncertainty, and other stressors at an already potentially stressful time

Helpful tips

It may be uncomfortable to talk about your wishes, but if you don’t, others may be more uneasy if ever left to make decisions on your behalf. The Cleveland Clinic recommends using The Conversation Project guide to help with end-of-life care conversations.

3. Talk To Your Doctor

Give a copy of your advance directives to your primary care physician to save in your medical record. You can also upload your AD via Cleveland Clinic MyChart, send it by mail or fax it to Cleveland Clinic at 216.445.9733.

It’s important for patients to talk about their wishes and values with their healthcare clinicians, including:

  • Physicians
  • Physician extenders like nurse practitioners and physician assistants
  • Chaplains, Advance Care Planning facilitators, Care Coordinators

Your healthcare goals may change over time, so you may have multiple conversations with your doctors. You do NOT need a lawyer to create advance directives documents. At the Cleveland Clinic we help patients to complete advance directives free of charge.

For more information, visit

Be Strong. Be Healthy. Be in Charge!

-Silvia Perez-Protto, MD, MS

Silvia Perez-Protto, MD, MS is an anesthesiologist and intensivist and Assistant Professor of Anesthesiology at the Cleveland Clinic Learner College of Medicine. She is the medical director of the End of Life Center at the Office of Patient Experience. Her work is aimed to standardize the advance care planning and end of life care at the Cleveland Clinic with the specific objectives to respect patients’ preferences, improve family experience and foster caregiver resilience.

Watch Dr. Silvia Perez-Protto's video as she expresses her passion to provide patients comfort in their final days. To contact Dr. Perez-Protto, please call the End Of Life Center at 216.444.9753.

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