1. Have you decided on a Power of Attorney for Personal Care and an alternative?
2. Do you have serious health issues you are concerned about?
3. What concerns do you have about how your health may change in the future?
4. What do I value most? Here are some examples of values you may want to think about:
- I want to live as long as possible
- I want to avoid the use of machines in order to keep me alive if I am seriously ill
- I want to avoid symptoms such as pain and shortness of breath
5. Do you want your health team to focus on maximizing the length of your life OR focusing on the quality of your life?
6. When you think about care at the end of your life, do you worry more about not getting enough care
or getting overly aggressive care?
7. Are you aware of the procedure of Cardiopulmonary resuscitation? Have you considered what you
would want should you experience a cardiac arrest?
*See PDF for link to CPR decision aid.
8. Do your hold any religious, cultural, spiritual or personal beliefs that influence your medical choices?
9. If you could no longer swallow to nourish your body would you rather have small amounts of food for pleasure knowing this will not sustain your existence or a feeding tube to maintain your daily nutritional requirements?
10. What are your concerns about future housing / residency in the event you can not remain in your primary residence?
11. Do you have a preference regarding location of care if you become unable to care for yourself in your home?
12. If you needed assistance with daily care needs who would you like help from? Is there anyone you would not want helping you?
13. Would you prefer to die alone or with others near you? Who would be important to have near you?
14. Would you want to donate your organs after you die?
15. When do you think death occurs i.e. when the heart stops beating; when the brain stops
functioning? Is there a level of existence to which you equate to being “as good as dead”?
16. What makes my life meaningful? (e.g. time with family or friends, faith, love for garden, music, art, work, hobbies, pet)
17. What are some important things that I want my SDM, family, friends and/or health care providers to understand about my future personal care wishes?
18. When you think about dying what are your greatest fears?
19. Would you consider Medical Assistance in Dying should your suffering become unbearable and you were competent to make your own decisions?
20. If you could create the perfect ending to your life story what would it look like?
More Questions to Ask
Click on PDF to link to "Plan Well Guide" to see how your values influence your perception of Quality of Life