LAST WISHES PART 2: The Document

Talk about difficult conversations—sitting your adult children down to hear how you want to be treated at the end of your life is about the worst. That’s why I met with Susan Plummer, PhD, who heads an organization that helps families with the Conversation.

Susan Plummer, PhD

Susan Plummer, PhD

In our last post we discussed the Conversation in which you share your end-of-life wishes with your grown offspring. Now, we will turn our attention to the document, called an Advance Care Directive (ACD), that makes your wishes legal. While most of us think of the ACD as a conveyance for our basic desires, such as “Do not resuscitate,” nowadays the document can be much more detailed, down to even the kind music you want to hear at the end! The ACD speaks for you when you cannot speak for yourself.
     Creating an Advance Care Directive is as important for your adult children as it is for you. At the time of a medical crisis there’s great confusion and grief. Families may argue about treatment, physicians may become demoralized by competing instructions, and the patient’s wishes my get lost in the shuffle. Moreover, without a blueprint to follow, after-grief may be complicated by regret. According to Dr. Susan Plummer of the Alliance for Living and Dying Well, there is evidence-based research that a month after a family member’s passing, those who had an Advance Care Directive to work with showed less anxiety, depression and post-traumatic stress syndrome than those who didn’t.
     Bear in mind that an ACD is not just for old people. Anyone over 18 should have one because when head injuries occur—and, let’s face it, accidents do happen to young people, too—they may not be able to communicate their wishes. Encourage your children, especially if they have children of their own, to fill out the form. It will force them to consider such key issues as guardianship and financial support until their children come of age. In fact, you can offer to fill out your ACD’s together. Once you’ve completed the document, keep the original with your other estate planning papers. Make copies for your adult children and whomever else will be involved, including your physician and your local hospital or clinic, where it should become part of your chart.
     There are different versions of the Advance Care Directive. Some forms are legal in some states and some in others, but even if you type out your wishes on a plain piece of paper, sign it, and have it notarized, the paper is legal. The Alliance for Living and Dying Well favors the Five Wishes, which has been used by more than 25 million people and is available online for $5 at Says the Alliance’s Director Susan Plummer, “There are many scenarios, not all of which you can anticipate, but if your offspring and physician get the gist of your end-of-life wishes, they are more likely to carry them out.”
     In future posts we will discuss healthcare agents and other aspects of advance planning, but for now please share how—or if—you’ve included your grown offspring in your end-of-life plans.

Susan Plummer, PhD, is Director of the Alliance for Living and Dying Well. She is the author of Deep Change: Befriending the Unknown and serves clients in her private psychotherapy practice. To contact Dr. Plummer, email her at

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