Advance Care Planning: Why Every Adult Should Have a Plan

There is a common saying in the medical community regarding preparing for future health needs: “It is always too early, until it is too late.”

Many of us spend significant time planning for life’s major milestones: weddings, retirement, buying a home, raising children. Yet we often neglect one of the most profound ways we can protect our future and our loved ones: advance care planning.

At my practice in Sugar Land, I often hear patients say they do not need a plan because they are currently healthy, or they believe these discussions are only for the elderly. However, accidents and sudden illnesses do not discriminate by age. Having a plan in place is not about anticipating the end. It is about taking control of your life and ensuring your voice is heard, even if you cannot speak for yourself.

What Is Advance Care Planning?

Advance care planning is the process of understanding and sharing your personal values, life goals, and preferences regarding future medical care. It supports adults at any age or stage of health in ensuring that if they become unable to make decisions for themselves, their wishes remain known and honored.

This is more than filling out a single form and filing it away. It is an ongoing conversation, a way of planning for the what-ifs of life. It involves thinking through the type of care you would want if you were unable to make healthcare decisions due to a crisis, a sudden accident, or a serious illness.

When we engage in advance care planning, we create a roadmap for our families and medical teams. This roadmap ensures that the care you receive aligns with what matters most to you. The documentation that comes from this process is called an advance directive, which may include a living will and the designation of a healthcare proxy. However, the primary goal is the conversation itself. The documentation simply records those discussions for clarity and legal purposes.

The Hard Truth: Why Many People Avoid Planning

Despite its importance, there is a significant gap between people’s wishes and their actions. The vast majority of Americans would prefer to die at home rather than in a hospital, yet only about 30 percent actually do. About 90 percent of people know they should discuss their end-of-life care preferences with loved ones, yet only about 30 percent actually have these conversations.

Only about one-third of adults have an advance directive expressing their wishes for end-of-life care. Among those 60 and older, that number rises to about half, yet many physicians remain unaware that these documents exist.

This silence has real consequences. When a crisis hits and no plan exists, family members are left to guess what you would have wanted. This can lead to:

• Agonizing Decision-Making: Loved ones experience immense stress, guilt, and regret when they are not confident they are honoring your wishes
• Care That Does Not Match Preferences: People often receive aggressive, hospital-based treatments when they would have preferred comfort care at home
• Family Conflict: Disagreements arise among siblings or relatives about what the patient would have wanted

Advance care planning removes this uncertainty. It gives your family permission and clarity to make decisions based on your values, not their fears or assumptions.

The Three Essential Steps

The process is straightforward and empowering. I recommend a three-step approach: Think, Discuss, and Document.

Step 1: Think

Before you look at a legal form, take time for self-reflection. Ask yourself:

• What gives my life meaning?
• What does quality of life mean to me? Is it being able to recognize family? Being independent? Being free from pain?
• What are my fears regarding medical treatment?
• If I had a serious illness, what trade-offs am I willing to make for more time?
• Are there religious or spiritual beliefs that guide my decisions about medical care?
• Who do I trust to make medical decisions for me if I cannot? This person is your healthcare proxy.

Step 2: Discuss

This is the most critical step. Have open, honest conversations with your family and your doctor. Do not assume your loved ones know what you want. Even close family members can have very different interpretations of your wishes.

Conversation Starters:

• “I was reading about medical planning, and it made me realize I have not told you what I would want in an emergency.”
• “If something happened to me, I would not want you to have to guess what to do. Can we talk about my wishes?”
• “I love you, and I want to make sure any medical decisions for me are easy for you because I have told you exactly what I want.”

You can also bring up the topic during your next annual physical. Your primary care doctor or a palliative care specialist can help facilitate this conversation, explaining the realistic outcomes of various treatments and helping you make informed decisions.

Step 3: Document

Once you have thought about your wishes and discussed them, put them in writing. This is your advance directive.

In Texas, the two primary documents are:

• Medical Power of Attorney: This names your healthcare proxy, the person with legal authority to make medical decisions for you according to your known wishes.
• Directive to Physicians and Family or Surrogates (Living Will): This states your wishes regarding life-sustaining treatment if you have a terminal or irreversible condition and are unable to communicate.

You can complete both on the same state-approved form. Once signed and witnessed, ensure that copies are distributed to your healthcare proxy, your primary care physician, your local hospital system, and key family members.

Keep a copy in an accessible location. Do not lock it in a safety deposit box where it cannot be reached during a weekend emergency. Consider keeping a copy in your glove compartment or a clearly marked folder at home.

Understanding the Key Legal Documents

The Living Will

A living will details the specific types of medical treatments you would or would not want. It typically addresses situations where you are terminally ill or permanently unconscious, and may include your preferences regarding:

• Resuscitation (CPR): Whether you want medical staff to attempt to restart your heart
• Mechanical Ventilation: Whether you want to be placed on a breathing machine
• Artificial Nutrition and Hydration: Your wishes regarding tube feeding
• Dialysis: Treatment for kidney failure

Healthcare Proxy (Medical Power of Attorney)

This document allows you to name a specific person to make medical decisions on your behalf. Your proxy does not necessarily have to be your spouse or your oldest child. It should be someone who is willing and able to take on the role, clearly understands your values and wishes, is capable of advocating for you even when other family members disagree, and can remain calm in a crisis.

Do-Not-Resuscitate Orders

A DNR order is a specific medical order written by a doctor that instructs healthcare providers not to perform CPR if your breathing or heart stops. This is distinct from an advance directive and must be discussed directly with your physician.

When Should You Review Your Plan?

Advance care planning is not a one-time task. Your views on life and medicine may change as you age. I recommend revisiting your advance directive during what I call the “5 D’s”:

1. Decade: When you hit a new milestone, such as turning 40, 50, or 60

2. Death: If a loved one passes away, it may change your perspective or require you to choose a new proxy

3. Divorce: If your spouse was your proxy, you may need to update your forms

4. Diagnosis: If you are diagnosed with a chronic or progressive condition

5. Decline: If your health status changes significantly

How Palliative Care Supports Your Planning

As a palliative care specialist, a significant portion of my work involves helping patients navigate complex medical decisions at any stage of illness. We view advance care planning as a pillar of patient-centered care. When you visit me, we can help you understand the medical implications of certain choices. For example, we can explain what CPR actually entails for a person with a chronic illness versus a healthy adult, helping you make informed decisions rather than decisions based on what you see on television.

We facilitate these conversations in a safe, supportive environment, ensuring that your plan reflects your true goals, whether that is aggressive intervention or a focus on comfort.

Addressing Common Concerns

“I am too young or healthy for this.”

This is the most common and most dangerous myth. A car accident, a sudden stroke, or an unexpected diagnosis can render anyone incapacitated. Planning when you are healthy ensures your voice is heard if you ever cannot speak.

“It means I am giving up.”

Choosing to decline certain high-risk, low-benefit treatments is not giving up. It is an informed choice to prioritize comfort, dignity, and quality of life. You can still choose all possible treatments. Advance care planning simply clarifies which treatments align with your definition of a life well-lived.

“My family knows what I want.”

Often, they do not. Explicit conversations prevent assumptions and conflict during the most stressful moments your family may ever face.

“It is too complicated or expensive.”

The thinking and talking are free. Texas statutory forms are available at no cost. While an attorney can help, it is not required. The most valuable part is the conversation, not the paperwork.

Taking the First Step

Thinking about a time when we cannot speak for ourselves is never easy. It requires courage and vulnerability. However, avoiding the topic does not prevent illness or accidents. It only prevents your preferences from guiding your care.

By completing your advance care planning, you are taking a powerful step to protect your autonomy. You are ensuring that if silence ever falls, your values will still speak clearly.

If you have not started this process, or if you have an old directive that needs updating, I encourage you to bring it up at your next appointment. At Kelsey-Seybold in Sugar Land, we are here to guide you through these decisions with compassion and expertise.

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Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for personalized medical guidance. To schedule an appointment with Dr. Vuslat Muslu Erdem, call (713) 442-9100.