Advance care planning – The overarching strategy that proactively addresses an individual’s health goals, values, preferences, and resources in anticipation of future medical conditions and decision-making needs.

Advance directive – A document that enables an individual capable of making decisions to articulate preferences and authorizations regarding health care.

Appointment directive (health care proxy, power of attorney for health care) is a document in which you legally appoint a health care agent/representative/proxy/power of attorney for health care) and authorize that person to make treatment decisions for you if you are ever temporarily or permanently unable to make these decisions for yourself. Your appointed agent will have the same decisional authority as you and will be able to confer with your care team in real time and make any decisions you would be able to make. The appointment of an alternate agent is recommended as a back-up in case your primary agent is unavailable or unable to make decisions for you.

Instruction directive (living will) is a set of instructions about specific tests or treatments that you would or would not want under specific conditions. The weakness of the instruction directive is that it requires you to anticipate future medical conditions that you may or may not experience and predict what types of care you would or would not want.

Decisional capacity – The ability to understand your medical condition and its likely course; the benefits, burdens, and risks of the proposed treatment options and alternatives; and their likely outcomes; and make informed care and treatment decisions based on the information. If you temporarily or permanently lose the capacity to make your own medical decisions, a surrogate (either an agent you have appointed in an advance directive or a close relative) will make decisions on your behalf.

DNR/DNI (do-not-resuscitate/do-not-intubate) order – A medical order to refrain from providing cardiopulmonary resuscitation (CPR) if your heart stops beating or breathing. Also called "No Code" order.

Durable power of attorney for health care – A document that names another person to make medical decisions for you if you are unable to make them for yourself. lt can include instructions about any treatment you would not want, such as a respirator, feeding tubes, chemotherapy, or radiation.

Feeding tubes – Tubes inserted through the nose, throat, or directly into the stomach to provide nutrition when the patient can no longer take nourishment by mouth.

Legal guardian – A person, usually appointed by the court, to take care of and manage the property and rights of another who is considered incapable of attending to his or her own affairs.

Life-sustaining treatments – Medical intervention administered to prolong life and delay death.

Living will – A document in which you stipulate the kind of life-sustaining care you would want if you become unable to make your own decisions.

Proxy – A person (also called an "agent" or "surrogate") appointed to make decisions for you if you become unable to make decisions. A proxy is designated through the execution of a durable power of attorney for health care.


Find your doorway to the sunnier side of this difficult discussion with these interactive conversation tools.

Death over Dinner
With Death over Dinner, you can transform difficult end-of-life conversations into "uplifting interactive adventures" complete with dynamic opportunities for engagement, insight, and empowerment each step of the way.

The Conversation Project
Grassroots public initiative, The Conversation Project, aims to bust the taboo on death discussions by fostering discourse across traditional and breakthrough media, while emphasizing the importance of making end-of-life wishes public before the hour arrives.

Death Café
A truly unique occasion, Death Café is a discussion group with just one topic: Death. By providing an open platform for honest, candid conversation, Death Café aims "to increase awareness of death to help people make the most of their (finite) lives."

How Doctors Can Approach End-Of-Life Conversations


These writings and reflections offer a unique, refreshing perspective on the topic of mortality.

Being Mortal
Riveting, honest, and humane, Atul Gawande’s Being Mortal shows that the ultimate goal is not a good death but a good life—all the way to the very end.

Decision Aids for Advance Care Planning: An Overview of the State of the Science
Advance care planning honors patients' goals and preferences for future care by creating a plan for when illness or injury impedes the ability to thin or communicate about health decisions.


Initiating any conversation begins by being as informed as possible. Start your journey here.

Aging with Dignity

American Bar Association

Atlantic Hospice

Caring Connections (National Hospice and Palliative Care Organization)
1-800-658-8898 (toll-free)

Decision Aids for Advanced Care Planning: An Overview of the State of the Science (PDF)

Donate Life America

Five Wishes – Aging With Dignity

Got Plans

How Doctors Can Approach End-of-Life Conversations (PDF)

Institute for Healthcare Improvement

The Living Bank
1-800-528-2971 (toll-free)

MedicAlert Foundation

Medicare Billing for Advance Care Planning FAQ


MyDirectives by Apple

National Institute on Aging

National Cancer Institute

National Hospice and Palliative Care Organization
1-800-658-8898 (toll-free)
1-877-658-8896 (toll-free/multilingual)

Health Resources and Services Administration
1-888-275-4772 (toll-free)

POLST (Physician Orders for Life-Sustaining Treatment)

      Delaware DMOST

      New Jersey POLST

      Pennsylvania POLST (Pennsylvania Orders for Life Sustaining Treatment)

Prepare For Your Care

American Hospital Association

Find forms by state (NJ) for state-specific laws and guidelines concerning advance directives and living wills:

New Jersey
Laws and forms


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