What is important to them and offers prompts to answer the questions
1st Box: This is to let your loved ones and health professionals know about you and what you value in your life.
Some examples
- Understanding my own health information and what is being explained
- Being orientated to myself and my surroundings
- Being able to recognise my family
- Having my person of my choice
- Maintaining the ability to independently move around and walk
2nd Box: What makes you happy and brings joy to your life?
Some examples:
- Engaging in spiritual or religious activities
- My culture, my food, my traditions
- Experiencing gestures of affection, like hugs or handholding
I am making this advance care directive of my own free will because:
1st Box: My health concerns are:
Some examples:
- What health conditions do you have?
- Any medical conditions diagnosed
2nd Box: My concerns for the future are:
How might your health impact your future plans?
- How might your health affect your loved ones?
- Where will you receive care?
- How will you handle pain if it happens?
- Being unable to communicate?
- Feeling like a burden?
- Going into care?
- How your family and loved ones will manage without you?
- Being confined to bed?
- Your family or loved ones not respecting your wishes?
- A clash between traditional and modern cultural practices?
- Financial concerns?