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Advance Directives and Hospice

Understanding advance directives in hospice care, including living wills, DNR orders, healthcare proxies, and how they work together with hospice services.

Written and reviewed by a board-certified hospice & palliative medicine physician

Last reviewed:

9 min read

Advance directives are legal documents that allow you to specify your healthcare preferences and appoint someone to make medical decisions for you if you become unable to do so. In hospice care, advance directives help ensure that your wishes are respected and that care aligns with your values and goals. Understanding advance directives and how they work with hospice can help you make informed decisions about your care.

Important: You can create or update advance directives at any time, including after entering hospice care. Your hospice team can help you understand your options and ensure your documents are properly completed and accessible.

What Are Advance Directives?

Advance directives are legal documents that communicate your healthcare wishes. The main types include:

Living Will

A living will specifies what medical treatments you want or don't want if you become unable to communicate your wishes. It typically addresses:

  • Life-sustaining treatments (ventilators, feeding tubes, etc.)
  • CPR and resuscitation preferences
  • Pain management preferences
  • Organ donation wishes

Healthcare Power of Attorney (Healthcare Proxy)

This document appoints someone (your "agent" or "proxy") to make healthcare decisions for you if you become unable to make them yourself. This person should:

  • Understand your values and wishes
  • Be willing to advocate for your preferences
  • Be available to make decisions when needed
  • Be someone you trust completely

Do Not Resuscitate (DNR) Order

A DNR order is a medical order (signed by a physician) that instructs healthcare providers not to perform CPR if your heart stops or you stop breathing. In hospice, DNR orders are common because:

  • CPR can cause additional suffering
  • The focus is on comfort, not life-prolonging measures

How Advance Directives Work in Hospice

In hospice care, advance directives help ensure that care aligns with your goals and values. Here's how they work:

Review During Admission

When you enter hospice, your hospice team will review any existing advance directives and help ensure they're current and accessible. If you don't have advance directives, they can help you create them if you desire.

Guiding Care Decisions

Advance directives guide your hospice team in making care decisions that align with your wishes. Your hospice team will respect your preferences and work to ensure care is consistent with your values.

Family Communication

Advance directives help families understand your wishes, reducing confusion and conflict during difficult times. They provide clear guidance when decisions need to be made.

Emergency Situations

If emergency medical services are called, advance directives (especially DNR orders) help ensure that emergency responders understand your wishes and don't perform unwanted interventions.

Creating or Updating Advance Directives

You can create or update advance directives at any time. Your hospice team can help you with this process:

Talk to Your Hospice Team

The hospice social worker or nurse can help you understand your options, answer questions, and guide you through the process of creating or updating advance directives.

State-Specific Forms

Advance directive forms vary by state. Your hospice team can provide you with the correct forms for your state and help you complete them properly.

Witnesses and Notarization

Most states require advance directives to be witnessed or notarized. Your hospice team can help ensure your documents are properly executed according to state law.

Distribution

Once completed, provide copies to your healthcare proxy, family members, primary physician, and hospice team. Keep the original in a safe, accessible place.

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