When instructing your health care agent about your wishes in the event you become incapacitated and they need to make health care decisions, we suggest you consider the following questions. We suggest no particular answers. Each person should answer these questions based on their own beliefs and convey those beliefs and wishes to their health care agent. Any other wishes or desires that you feel your heath care agent should know should also be given to them so that they can carry out their responsibilities as you would wish.

• Do you want to donate parts of your body to someone else at the time of your death? (This is called "organ donation.")
• Do you think you would want to have any of the following life-sustaining medical treatments performed on you?
  • Kidney dialysis (used if your kidneys stop working)
  • Cardiopulmonary resuscitation, also called CPR (used if your heart stops beating)
  • Respirator (used if your are unable to breathe on your own)
  • Artificial nutrition (used if you are unable to eat food)
  • Artificial hydration (used if you are unable to drink fluids)
• How would you describe your current health status? If you currently have any medical problems, how would you describe them?
• If you currently have medical problems, in what ways, if any, do they affect your ability to function?
• How do you feel about your current health status?
• If you have a doctor, do you like him or her? Why? Do you think your doctor should make the final decision about any medical treatments you might need?
• How important is independence and self-sufficiency in your life?
• If your physical and mental abilities were decreased, how would that affect your attitude toward independence and self-sufficiency?
• Do you expect that your friends, family and/or others will support your decisions regarding medical treatment you may need now or in the future?
• What do you think will be important to you when you are dying (e.g. physical comfort, no pain, family members present, etc.)?
• What is your attitude toward death? Where would you prefer to die?
• How do you feel about the use of life-sustaining measures in the face of terminal illness?
• How do you feel about the use of life-sustaining measures in the face of permanent coma?
• How do you feel about the use of life-sustaining measures in the face of irreversible chronic illness (e.g., Alzheimer's disease)?
• Do you wish to make any general comments about your attitude toward illness, dying and death?
• What is your religious background? How do your religious beliefs affect your attitude toward serious or terminal illness?
• Does your attitude toward death find support in your religion?
• How does your faith community, church or synagogue view the role of prayer or religious sacraments in an illness?
• Do you wish to make any general comments about your religious background and beliefs?
• What else do you feel is important for your agent to know?

If, over time, your beliefs or attitudes in any area change, you should inform your health care agent. It is also wise to inform your health care agent of the status of your health when there are changes such as new diagnoses. In the event you are informed of a terminal illness, this, as well as the ramifications of it should be discussed with your health care agent. How well this individual performs depends on how well you have prepared him or her.

NOTICE

THIS INFORMATION IS NOT OFFERED AS LEGAL ADVICE BUT ONLY AS GENERAL INFORMATION ABOUT TOPICS OF INTEREST TO SENIOR CITIZENS AND THEIR CAREGIVERS. YOU SHOULD NOT RELY ON THE LIMITED INFORMATION PROVIDED HERE, BUT ARE URGED TO CONSULT WITH A QUALIFIED ELDER LAW ATTORNEY FOR LEGAL ADVICE BASED ON YOUR PARTICULAR , INDIVIDUAL CIRCUMSTANCES.