End-of-Life Decisions

This section of your directive expresses your treatment preferences for situations where you have a terminal condition, persistent vegetative state, end-stage condition, or advanced irreversible cognitive decline.

What are end-of-life decisions?

End-of-life decisions document your wishes for medical treatment when you are seriously ill and cannot speak for yourself. Without these documented preferences, the default medical practice is to attempt all available treatments to sustain life.

This section of your advance directive is different from a DNR (Do Not Resuscitate) or POLST (Physician Orders for Life-Sustaining Treatment) order. A DNR/POLST is a physician-signed medical order that emergency responders must follow. Your advance directive expresses your wishes and informs those physician orders.

The three approaches

Do not prolong my life

This approach focuses on comfort and allowing a natural death. All life-prolonging treatments are set to refuse, and comfort-focused care is provided. This is often chosen by people who prioritize quality of life over length of life when facing a terminal or irreversible condition.

Prolong my life as long as possible

This approach directs physicians to use all available treatments to extend your life within accepted medical standards. Comfort care is also provided alongside life-prolonging treatments. This is often chosen by people who want every possible measure taken.

I trust my Healthcare Agent to decide

This approach delegates all end-of-life treatment decisions to your named Healthcare Agent, who will work with your physicians. This is often chosen by people who prefer a trusted person to evaluate the specific circumstances rather than making blanket decisions in advance. You must have a named Healthcare Agent for this option.

Individual treatments explained

CPR / Resuscitation

Cardiopulmonary resuscitation (CPR) is an emergency procedure that uses chest compressions and sometimes electric shocks to restart a stopped heart. In the context of a terminal illness or end-stage condition, CPR has a low success rate and may result in broken ribs, brain damage, or a brief return to a diminished state.

Mechanical Ventilation

A mechanical ventilator is a machine that breathes for you when you cannot breathe on your own. It requires a tube inserted into your windpipe. A time-limited trial means trying the ventilator for a set period, then reassessing whether it is helping.

Artificial Nutrition (Feeding Tube)

Artificial nutrition delivers food through a tube placed in the nose, throat, or directly into the stomach. It can be temporary or long-term. In end-of-life situations, artificial nutrition may prolong the dying process without improving comfort.

Artificial Hydration (IV Fluids)

Artificial hydration delivers fluids through an intravenous (IV) line when you cannot drink. In end-of-life situations, the body naturally reduces its need for fluids, and artificial hydration can sometimes cause discomfort such as swelling or fluid in the lungs.

Dialysis

Dialysis is a treatment that filters waste and excess fluid from the blood when the kidneys can no longer do so. It typically requires several sessions per week, each lasting several hours. In end-of-life situations, dialysis may extend life but carries significant burden.

Antibiotics for Life-Threatening Infection

In end-of-life situations, infections such as pneumonia can be a natural part of the dying process. Antibiotics can treat these infections, but doing so may prolong suffering when the underlying condition is terminal. Some people choose to refuse antibiotics to allow a more natural death.

Comfort-Focused Care

Comfort-focused care (palliative care) prioritizes pain relief, dignity, and quality of life. It includes medication for pain and anxiety, keeping you clean and comfortable, and emotional support. Most people want comfort care regardless of their other end-of-life decisions.

Understanding your options

Accept — You want this treatment attempted if your physician recommends it.
Refuse — You do not want this treatment, even if it could extend your life.
Time-limited trial — Try the treatment for a defined period, then reassess. Available for ventilator, feeding tube, IV fluids, and dialysis.
Agent decides — Your Healthcare Agent will make this specific decision in consultation with your physicians, based on the circumstances at the time.

How this relates to your directive

Your Healthcare Agent is the person who carries out these wishes if you cannot speak for yourself. If you delegate decisions to your agent, make sure they understand your values.
A DNR or POLST is a separate physician-signed order. EMTs and paramedics can only follow these orders, not your advance directive directly. Ask your physician about getting a DNR or POLST if you choose "do not attempt" for CPR.
If you have chosen to donate organs, some life-sustaining treatments may be briefly continued to preserve organs for donation, even if you have otherwise refused them.

Common questions

Can I change my mind?

Yes. You can update your directive at any time while you are competent to make decisions. Your most recent directive takes precedence.

What if my doctor disagrees?

Physicians have conscience clauses that may allow them to refuse certain requests. If this happens, they are generally required to transfer your care to a physician who will honor your wishes.

Does this replace a DNR?

No. This directive expresses your wishes, but emergency responders can only follow physician-signed DNR or POLST orders. Ask your physician about obtaining these orders.

What if I don't fill this out?

Without documented end-of-life preferences, physicians will generally attempt all available treatments to sustain life. Documenting your preferences ensures your wishes are known.