Making End-of-Life Healthcare Decisions: A Guide to Advocating for Your Loved One

Making your own healthcare decisions is difficult—but making medical decisions for a loved one near the end of life can be overwhelming. Even if your loved one has an advance directive or a living will, it may not cover every possible situation. So how do you advocate for a loved one when they can’t speak for themselves?

1. Rely on Advance Directives, If Available

There are two main types of documents that make up advance directives:

• Healthcare Power of Attorney (POA): Your loved one may have named you as their healthcare proxy or representative, giving you the legal authority to make decisions on their behalf.
• Living Will or Healthcare Directive: This outlines which medical treatments your loved one does or does not want—such as CPR or intubation.

Make sure copies of these documents are shared with the healthcare team, and that you’ve had conversations with doctors and bedside staff about your loved one’s wishes.

If care is happening at home, a POLST (Physician’s Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) may also be required to guide emergency responders. Letters or videos expressing medical preferences can help inform care, though they are not legally binding.

2. What to Do If There Are No Documents

If there’s no legal guidance in place, here are a few ways to navigate decision-making:

• Revisit Past Conversations: Reflect on what your loved one has said about life, death, or healthcare decisions—these clues can help you make choices that honor their values.
• Focus on What They Enjoy: Consider their daily joys. If they love being alert to talk with family, for example, choose treatments that prioritize mental clarity.
• Talk to Others: Family members or close friends may have additional insight into what your loved one would want.

3. Consider Cultural and Religious Beliefs

End-of-life care can be deeply influenced by faith, culture, and ethnicity. Ask:

• Are there religious or cultural traditions to respect at the end of life?
• Are there specific treatments that are or are not acceptable?
• Who is traditionally expected to make decisions in our family or culture?

You can share these insights with caregivers using prompts like:

• “Our faith asks us to…”
• “When someone is dying in our family, we…”
• “Where we are from, we prefer…”

4. Ask the Right Questions

You are the expert on your loved one’s life—don’t hesitate to ask healthcare professionals for clarity. Questions may include:

• What can we expect in the coming days/weeks/months with or without treatment?
• If we start a treatment and then stop it, what happens?
• How can we help them stay alert enough to do what they enjoy?
• What services does hospice care provide or not provide?
• What pain relief options are available?

Always ask for explanations if something is unclear, and consider having someone take notes during important discussions.

5. Use Substitute Judgment and Best Interest Standards

There are two primary ways to make decisions for someone else:

• Substitute Judgment: Make the decision your loved one would have made. For example, if they wished to die at home, prioritize that if possible.
• Best Interest Standard: Weigh the pros and cons from your own perspective to decide what’s best for their comfort and dignity.

Often, these approaches overlap, and using both can help guide compassionate and informed decisions.

Start the Conversation Early

The best way to prepare for end-of-life healthcare decisions is to have open conversations long before a crisis. Talk about values, goals, and medical preferences now—and make sure all legal documents are completed and accessible. This planning not only honors your loved one’s wishes but also brings peace of mind during one of life’s most challenging moments.

‍
Contact Us to speak with a member of our care team and discover how LiveWell can support you and your loved one.

‍