End-of-life care planning is uncomfortable but important. Discussing preferences while you're well ensures your wishes are respected when you can't communicate them.
Advanced care planning
An advanced care plan (or advance statement) documents your preferences if you become seriously ill: What treatment do you want or not want? Who should make decisions if you can't? What quality of life is acceptable to you?
This is separate from a will (which distributes possessions) and is about healthcare preferences.
Discussing this with your GP is good practice. They can document your preferences and ensure they're communicated to specialists and hospitals. A copy in your medical records matters.
Do Not Attempt Resuscitation (DNAR)
DNAR orders document that if your heart stops, CPR won't be attempted. For people who are terminally ill or whose quality of life makes survival after CPR unacceptable, this is often appropriate.
DNAR should be discussed before it's needed, not decided in crisis. Clarify: Do you want to attempt CPR if your heart stops, knowing your age and health status make success unlikely?
DNAR order is not "do not treat"—it's specific to CPR. You still get other treatment, medications, care. It's about not doing chest compressions and intubation specifically.
Lasting Power of Attorney (LPA)
LPA appoints someone to make healthcare decisions if you become unable to. This might be family, friend, or solicitor. Without LPA, decisions default to your doctors and next of kin, which can be complicated.
Getting LPA set up costs £100-200 with a solicitor, or you can do it yourself (more complex). It's worth doing if you have strong preferences about your care.
Preferred place of death
Do you want to die at home, hospice, or hospital? This affects planning months in advance. Home death requires support structure (family, community nursing), which may or may not be possible. Hospices have waiting lists. Planning early helps ensure your preference is possible.
Symptom management at end of life
Good end-of-life care prioritizes comfort over extending life. Pain control, management of nausea, shortness of breath, anxiety—all matter more than investigations or treatments that extend life slightly.
Palliative care specializes in this. If you're terminally ill, ask your doctor for palliative care referral. These teams make the final phase as comfortable as possible.
Hospice care
Hospices provide specialized end-of-life care, usually residential. Most are free on the NHS or free-to-patient through charitable funding (they're charity-run, funded by NHS and donations).
Hospices handle symptom management, emotional support, family support. Some offer day services (not just residential). Referral happens when life expectancy is weeks to months, though this varies.
Talking about it
Many people avoid discussing end-of-life preferences because it feels morbid or like giving up. It's not. It's ensuring your values guide your care when you can't communicate them yourself.
Start with your GP: "I want to discuss my preferences if I become seriously ill." Most GPs appreciate this conversation and will help document your wishes.
Specific advance care planning decisions
Artificial nutrition and hydration: If you become unable to swallow or eat, do you want a feeding tube (PEG—inserted into your stomach, or NG—nose-gastric tube)? These can prolong life in some situations but don't significantly extend meaningful life if your illness is terminal. Many people opt against artificial nutrition in end-stage dementia or terminal cancer. Document this.
Artificial ventilation: If your breathing fails, do you want mechanical ventilation? For some conditions (recoverable pneumonia, accident recovery), this is temporary and worthwhile. For terminal illness, ventilation without hope of recovery extends dying without benefit. This is important to specify.
Organ support: Dialysis for kidney failure, for example, can be life-sustaining for years or can become a burden extending a dying process. Clarify whether you want dialysis if diagnosed with kidney failure in advanced age or terminal illness.
Antibiotics: Do you want antibiotics for infections? In terminal illness, infection is often a gentle way to death. Many people opt to decline antibiotics in this setting. Ensure this preference is documented if relevant to you.
Who decides if you can't
Without LPA, NHS doctors and your next of kin (in order: spouse/civil partner, children, parents, siblings) make decisions together. If there's disagreement, the healthcare team defers to those most involved with your care and closest to your values.
Ideally these conversations happen before crisis. If you're acutely ill and unconscious, family needs to tell doctors your values and preferences quickly. Much better if this is documented.
Mental Capacity Act (2005) governs this: anyone is assumed to have capacity unless proven otherwise. If you're conscious and alert, you can refuse treatment even if doctors disagree. The NHS must respect your refusal. If you lack capacity, your previous wishes (advance statement) and then your LPA or next of kin guide decisions.
Practical advance statement vs formal LPA
Advance statement: written document of your values and preferences. Free to create (write it yourself or with GP input). Less legally binding than LPA but documents your wishes. Keep copies with GP, family, and somewhere accessible.
LPA (Lasting Power of Attorney): legally binding document appointing someone to make decisions. Costs £110-200 to register (Office of the Public Guardian). More formal, more legally secure.
Many people do both: write an advance statement (clarifying values and preferences) and establish an LPA (appointing specific person to decide if needed).
Financial and practical aspects
Funeral planning: discuss with family whether you want burial or cremation, religious rites if applicable, type of funeral service. Money set aside for funeral costs (average £4,000-5,000 in UK) reduces burden on family. Funeral planning services exist if you want to pre-arrange and pay.
Will and estate: separate from end-of-life care planning, but important to have clear will. Intestacy (dying without will) creates complexity and delay for family. Simple will from solicitor costs £200-400.
Communication of preferences: ensure your advance statement and LPA are known to family. Leave copies with key people: GP, hospital if you have one, family members, anyone you've appointed.
Specialist palliative care advice
If you have a terminal diagnosis or chronic serious illness, ask your doctor for palliative care consultation early. You don't need to be dying to benefit from specialist palliative input. They help clarify goals, manage symptoms, and plan for what matters most to you.
Macmillan Cancer Support, Marie Curie, and other organisations provide palliative care information and often support (sometimes specialist nurses or counselors) at minimal cost or free on NHS.
The conversation with family
Many people avoid this conversation because it feels morbid. Reframe it: you're clarifying your values and ensuring your family isn't burdened with decision-making in crisis. You're giving them a gift—clarity about what you want.
Time it for calm, non-crisis moments. Not during serious illness scare, but when you're healthy. "I've been thinking about my values if I become seriously ill, and I want to discuss this with you." Most family appreciate the opportunity to understand what matters to you.
You don't need all answers immediately. "I know if I had advanced dementia and caught pneumonia, I wouldn't want aggressive treatment, but I'm still thinking about dialysis" is fine. This evolves as you age and circumstances change.
Revisit it: preferences can change. If you've done advance planning at 50, review it at 70. Values sometimes shift and new scenarios become relevant.