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    How to get the care you want at the end of life

    New data show that Massachusetts residents spend many of their final days in the hospital, instead of at home or in hospice care. Planning ahead can make it more likely that people get the care they desire. Here are steps individuals can take.

    Think about it.

    Do you know what you want? It’s impossible to foresee what circumstances could bring you near death or leave you unable to speak for yourself — whether a car accident or a prolonged illness. And it may be equally difficult to predict how you will feel about specific treatments or disabilities.

    But you do know what you value in life. Dr. Atul Gawande, the surgeon and author, recommends you contemplate the minimum you would need to make life worth living, and treatments you would be willing to endure in exchange for more weeks or months of life.


    The Conversation Project, a nonprofit that promotes end-of-life planning, offers advice on how to think about your goals and values on this page.

    Talk about it.

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    It’s essential those close to you know your wishes. Don’t assume they will know what’s best for you — people are often surprised. The Conversation Project recommends some ice breakers: for example, when asking elderly parents to discuss their wishes, pose the question as a request for help; when telling adult children your own wishes, point out they’ll be grateful you talked about the issue.

    It’s also critical to speak with your doctor — both to explain what you want, and to ensure the doctor shares your values. The biggest predictor of whether a doctor refers someone to hospice is how often that doctor has previously made hospice referrals. Your physician’s attitude will have a huge impact on your care.

    Choose a health care proxy.

    Your health care proxy is a person designated by you to make decisions about your care if you are incapacitated. Without giving someone this power in advance, you risk having crucial decisions made by relatives who don’t know what you want or who disagree with each other.

    Fill out the forms.

    There are five health care planning documents available. Here are descriptions and links to the documents, courtesy of Honoring Choices Massachusetts , another group concerned with end-of-life issues.


    Health care proxy: Designates your health care agent, the person legally empowered to make medical decisions on your behalf when you are unable to do so.

    Personal directive or living will: A document explaining your preferences to your health care agent. Personal directives and living wills are not legally binding in Massachusetts but can clarify your wishes to those entrusted with carrying them out.

    Durable power of attorney: A legal document, usually filled out with an attorney, designating a person to manage your money, property, and finances if you are incapacitated.

    Medical Orders for Life-Sustaining Treatment (or MOLST: A medical order prepared with a physician in which adults with advanced illness detail their preferences for care.

    Comfort Care/Do Not Resuscitate Order: A medical document that directs medical personnel not to restart your heartbeat and breathing.

    Felice J. Freyer can be reached at Follow her on Twitter @felicejfreyer