Advanced Care Planning

Step 5: Determine How You Want Your Medical Decision-Maker to Take Action

Now that you have assessed your values and considered various situations, think about how you would want your medical decision-maker to act on your behalf.

In the table below, select the items that you would like your medical decision- maker to consider and write any additional comments for clarification.

When making medical decisions on my behalf...
Comments (if needed)

Try to follow my wishes as strictly as possible.

I trust you and know that you would make the right choice, no matter what.

Seek the advice of a trusted personal physician to see what he or she feels would be in my best personal interest.

Please explore every possible treatment option, including seeking second opinions and experimental treatments that might be available.

Talk to friends, family and religious leaders for advice.

Consider cultural and/or religious values that are important to me.

Step 4

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