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)
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.
VIEW: After the Heart Attack - Dr. Flanigan on Advance Care Planning and End of Life MP3
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.
VIEW: Advance Directives and Spending at the End of Life MP3
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.
VIEW: Too Soon to Give up on Advance Directives MP3
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.
VIEW: Creating Caring Conversations for Young Adults MP3
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.
VIEW: Caring Conversations – A Partnership Between You and Your Agent MP3
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.
VIEW: Ambivalence about End of Life Planning and Assisted Suicide MP3
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.
VIEW: Organ Donations and Presumed Consent MP3
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.
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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.
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Articles
Guest Editorial on the Usefulness of Advance Directives
Myra Christopher, Bioethics Forum, Summer 1997
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Physician Assisted Suicide: A Different Approach
Linda Emanuel, Bioethics Forum, Summer 1997
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A Practical Advance Directive Survey
Tony McCanna, Bioethics Forum, Summer 1997
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Reflections on Cultural Difference and Advance Directives
Vicki Michel, Bioethics Forum, Summer 1997
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Advocating for the Dying: The View of Family and Friends
Anna Moretti, Bioethics Forum, Summer 1997
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Beyond Living Wills
Mark Tonelli, Bioethics Forum, Summer 1997
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Difficult Decisions in Health Care: One Woman’s Journey
Marcia K. Walsh, Bioethics Forum, Summer 1997
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Missouri’s Living Will Law
Marcia J. Lamkin, Midwest Medical Ethics, Spring 1986
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Beyond the Law: A Philosophical Note on the Missouri Death Prolonging Procedures Act of 1985
Hans W. Uffelmann,
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Living Wills
Robert M. Veatch, Midwest Medical Ethics, Spring 1986
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OTHER
The Right Way to Craft a Living Will
Bloomberg News
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Pathways to Convergence Report
The Center for Practical Bioethics with the support of Pew Charitable Trusts engaged a small group of Catholic leaders from clinical, clerical, ethical, and theological perspectives in an extended discussion to explore areas of convergence and divergence around palliative care and advance care planning in American society. This steering group independently designed and directed the effort. That initial group also identified an additional two dozen Catholic leaders from diverse professional perspectives, educational backgrounds, and geographic regions to join in the discussion.
Catholic Perspective on Palliative Care (Booklet)
Catholic Perspective on Palliative Care (Manuscript)
Catholic Perspective on Palliative Care (Single Page Layout)
