Advance Care Planning

Advance Care Planning

  • Advance Care Planning Resources

    Caring Conversations® Workbook:

    The Caring Conversations® Workbook will guide you, your family and your friends through the process of advance care planning with a highly individualized focus. The Workbook includes a Durable Power of Attorney for Healthcare Decisions form for your use.

    Caring Conversations (DOWNLOAD)

    Caring Conversations for Young Adults (DOWNLOAD)


    Healthcare Directives:

    Healthcare Directive/Durable Power of Attorney, English (DOWNLOAD)

    Out of Hospital Do Not Resuscitate Form (Kansas) (DOWNLOAD)

    Witnessing Rules for Advance Directives in Missouri and Kansas (DOWNLOAD)

  • Audio Interviews

    After the Heart Attack - Dr. Flanigan’s Views on Advance Care Planning and End of Life

    In early 2012, at age 85, Dr. Rosemary Flanigan suffered and survived a heart attack. Fifteen years earlier, Dr. Flanigan wrote: “It makes me mad. There’s a pervasive assumption out there that should I, one day, have a coronary infarct, I would want to be resuscitated. That is simply not true. I am 71 years old and in good health…So when I am doing what I enjoy doing and am fortunate enough to suffer an infarct rather than a slow and painful death from cancer or ALS or the darkening of Alzheimer’s, then I want to be let go.” In this September 2012 recording, Dr. Terry Rosell, Rosemary Flanigan Chair at the Center, questions Dr. Flanigan about how her views on end of life and advance care planning may have changed since her heart attack. Dr. Flanigan explains that the heart attack made her reflect on how careful we must be in our advance directives and the importance of choosing a surrogate decision-maker.

    Advance Directives and Spending at the End of Life

    On October 5, 2011, the Journal of the American Medical Association reported the results of a study indicating that advance directives specifying limits at the end of life may have their greatest impact in regions where the norms are to provide high-intensive end-of-life treatment. In this interview, Myra Christopher, then president and CEO of the Center, says that the study substantiates the Center’s belief that patients are provided care consistent with their individual goals and values and appropriate for their condition do not spend as much money and discusses other studies that validate a causal link between advance care planning, spending and burdens on families.

    Too Soon to Give up on Advance Directives

    Advance directives were the subject of a 2010 study in the New England Journal of Medicine, also the fifth anniversary of the death of Terri Schiavo. So where do advance directives stand these days and how might we make better use of them? Michael Green, MD and Benjamin Levi, MD of the Penn State College of Medicine discuss the study about advance directives in an elderly population, focusing on the distinction between advance directives and advance care planning and adaptive preference formation. They offer a computer-based approach to advance directives in the April 2010 issue of the American Journal of Bioethics.

    Creating Caring Conversations for Young Adults

    For more than a decade, the Center for Practical Bioethics has offered a booklet called Caring Conversations to help individuals and their families make practical preparations for end-of-life decisions. Now the Center has tailored a version of Caring Conversations for use by young adults. Dr. Barbara Bollier and Lauren Douville discuss why this workbook for young adults was needed, how it was created, and what makes it different from the original Caring Conversations.

    Caring Conversations – A Partnership Between You and Your Agent

    The Center has promoted Caring Conversations for years as a way for families to prepare for serious illness or the end of life. Over time, it became apparent that, oftentimes, even when a person appointed an agent to speak for them when they could no longer speak for themselves, neither the person nor the agent fully understood their roles and responsibilities. Thus, in 2013, the Center published a major revision of Caring Conversations, which two of the authors, Sandy Silva and Helen Emmott, discuss in this recording. The revision emphasizes the partnership between the person and his or her agent or surrogate.

    Ambivalence about End of Life Planning and Assisted Suicide

    In 2012, American Medical News reported two not wholly unrelated articles. One article was about the Supreme Court of Georgia striking down a law intended to prevent assisted suicide. The other article reported a survey in California that showed that 76% of patients neglect end of life planning but 86% believe it’s important to put end of life wishes in writing, and only 8% of patients remember being asked by physicians about their end of life wishes.  John Carney, president and CEO of the Center, discusses the implications of the two stories.

    Organ Donations and Presumed Consent

    Organ donations were in the news in 2010 as legislatures in New York, California and other states considered presumed consent -- making everyone an organ donor unless they opt out --and physicians considered whether it should be part of advance care planning. Terry Rosell, the Rosemary Flanigan Chair at the Center for Practical Bioethics, explores some of the ethical issues raised by presumed consent.


  • Case Studies

    Melinda’s Story

    Melinda Roberts is a 31 year old African-American female who, two years prior to her present illness, had completed an advance directive and had also appointed a durable power of attorney for health care. When she was 17 years old, Melinda had an episode of myasthenia gravis, which resulted in 4 weeks in ICU.

    A Family Divided

    A forty-five-year-old man with a three-year history of cardiovascular disease has entered the hospital with a stroke that has paralyzed his right side and caused him to aspirate food of any consistency. His mental status is clouded and there is disagreement as to whether or not he has decisional capacity. His language capacity is only “yes” and “no,” and his responses are inconsistent.

  • Articles

    Guest Editorial on the Usefulness of Advance Directives
    Myra Christopher, Bioethics Forum, Summer 1997

    Physician Assisted Suicide: A Different Approach
    Linda Emanuel, Bioethics Forum, Summer 1997

    A Practical Advance Directive Survey
    Tony McCanna, Bioethics Forum, Summer 1997

    Reflections on Cultural Difference and Advance Directives
    Vicki Michel, Bioethics Forum, Summer 1997

    Advocating for the Dying: The View of Family and Friends
    Anna Moretti, Bioethics Forum, Summer 1997

    Beyond Living Wills
    Mark Tonelli, Bioethics Forum, Summer 1997

    Difficult Decisions in Health Care: One Woman’s Journey
    Marcia K. Walsh, Bioethics Forum, Summer 1997

    Missouri’s Living Will Law
    Marcia J. Lamkin, Midwest Medical Ethics, Spring 1986

    Beyond the Law: A Philosophical Note on the Missouri Death Prolonging Procedures Act of 1985
    Hans W. Uffelmann,

    Living Wills
    Robert M. Veatch, Midwest Medical Ethics, Spring 1986


    The Right Way to Craft a Living Will
    Bloomberg News