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Some topics are understandably difficult to broach, from telling your boss she has broccoli in her teeth to educating your child about the ‘birds and bees.’ However, the conversation almost everyone fears the most involves the inevitability of death and the practical matters surrounding it. In fact, according to a survey conducted by the
Conversation Project, a public engagement campaign launched in collaboration with the Institute for Healthcare Improvement (IHI), only 30 percent of adults have talked about their wishes for end-of-life care with their loved ones.

This is despite 90 percent agreeing it’s an important subject, and even Medicare recognizes the value of this particular discussion.  As of January 2016, the organization has begun reimbursing physicians for the time spent talking with their patients about future medical decisions and the care they wish to receive at the end of their lives.

If you have not yet had this essential conversation with your family, experts urge against delay. Not only will honest communication—and the proper legal documents—ensure your wishes are met in your final days, but it can also reduce the stress on your loved ones during a difficult time.

You may want to begin by discussing who should make decisions on your behalf when the time comes that you are unable to do so on your own. You may have family member who are more comfortable with this responsibility than others. Choose one you trust to respect your wishes regardless of his or her personal preferences.

Put your desires in writing. It’s important to prepare both a healthcare proxy (also known as a medical power of attorney) and a living will. These legal documents will spell out who will speak for you when you’re unable to speak for yourself as well as your end-of-life decisions. You can find advance directive documents at CaringInfo, the website of the National Hospice and Palliative Care Organization. You can fill out these forms on your own, though they must be notarized and witnessed to be valid.

The healthcare proxy will name the friend or family member you want to act as your surrogate decision maker. The living will document will describe the treatments you want—or do not want—as you approach death. These include mechanical ventilators, dialysis and organ donation as well as palliative care. Your physician is an excellent resource when preparing a living will. He or she can describe various end of life treatments as well as their risks and benefits.

Because advance directives may not always be followed by all medical personnel in an emergency situation, you may also wish to create a medical order (also known as a POLST or Physician Orders for Life-Sustaining Treatment). A POLST applies to all medical staff, including the ambulance team and emergency room personnel. If you do not wish to be resuscitated in an emergency situation, make sure your POLST includes a DNR (do not resuscitate) order.

Your completed advance directives should be copied and given to your spouse or partner, children, lawyer and physicians. They should also be scanned into your electronic health record. Take the time to revisit these directives periodically and update them according to any change in your wishes or desired proxy.


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