Most people want the same things at the end of life: comfort, control, and the ability to make decisions based on their own values. Research shows that while nearly two-thirds of Americans say they’ve thought about their end-of-life care preferences, fewer than one-third have completed an advance directive. This gap can have serious consequences, especially during medical emergencies when decisions must be made quickly.

Emergency physicians regularly see what happens when preferences aren’t documented. Studies show that patients without advance directives are significantly more likely to receive aggressive interventions they may not want. Emergency medical service (EMS) teams and emergency department clinicians are trained to preserve life unless there is clear, accessible documentation stating otherwise. 

But you can close that gap. More hospitals and clinics are embracing a framework that puts patients at the center: the Age-Friendly Health Systems model, which organizes care around the “4Ms” — What Matters, Medication, Mentation, and Mobility. “What Matters” sits at the heart of this approach. When you express what matters to you clearly — whether through conversations, advance directives, or medical orders — your healthcare team has a better foundation for decisions that reflect your priorities. Taking a few practical steps now, whether you’re navigating a chronic illness, supporting a loved one, or simply planning ahead, can help bridge the gap between your values and your care.

Aligning care with your values

The most effective way to ensure you get the care you truly want is to connect your personal goals with clear, actionable instructions. That process involves three key steps.

1. Start the conversation. Start by sharing what matters most to you with the people who may one day speak on your behalf. Think of this as the first of many talks that can be revisited and refined as your needs and health change. Early conversations build shared understanding, clarify your priorities, and lay the groundwork for future medical planning. 
2. Document. Put your wishes into writing. An advance directive provides healthcare instructions  and names a healthcare proxy. If you are living with serious illness or frailty, discuss completing a physician/medical orders for life-sustaining treatment (POLST/MOLST) with your care provider to translate those preferences into signed medical orders that emergency responders and hospital teams can follow. 
3. Share. Make sure your documents get to the right hands. Give copies to your proxy, your loved ones, and your healthcare team, and keep them somewhere EMS can easily find them during an emergency.

These steps work together to ensure your care reflects what you want, even when you cannot speak for yourself.

When dinner table conversations matter most

Victor Silva never wanted to talk about death. For years, he avoided the conversations his father would bring up at the dinner table — discussions about not wanting to suffer, about preferring a peaceful end. Victor thought talking about it might somehow make it happen sooner.

Years later, when Victor became his parents’ caregiver alongside his husband, Luis, those uncomfortable conversations became invaluable. When his mother could no longer swallow and hospital staff wanted to insert a feeding tube, the doctor asked Victor, as his mother’s medical power of attorney, what he wanted them to do. “I knew Mom wanted to be comfortable at the end of her life, and I had promised her that I would make sure that she was as happy as she could be until the very last second. At the same time, part of me wanted to keep her around. But I knew respecting her wishes to have a peaceful and gentle end was more important than my desire to keep her on this earth. Still, this was not an easy decision. I talked with my sister and her daughters, and we prayed, and together we decided to do what we knew Mom wanted: to let her go.”

When you’re put on the spot in those moments, it can be incredibly hard to make that call. But Victor is grateful now for those dinner table conversations he once squirmed through — they gave him the clarity to honor what his parents wanted, even when it wasn't easy.