National Healthcare Decisions Day
National Healthcare Decisions Day is an important event that encourages people to discuss and document their healthcare wishes. At its core, the day is about clarity.
Position advance care planning services and legal/financial tools as essential family conversation starters during National Healthcare Decisions Day.
- Family conversation guide: 5 questions to ask before a health crisis hits
- Free advance directive templates and checklist for April planning
- Why 70% of families avoid healthcare talks—and how to start yours
- Healthcare lawyer Q&A: Common misconceptions about end-of-life planning
National Healthcare Decisions Day (NHDD) was founded in 2008 by Nathan Kottkamp, a healthcare lawyer. He created this day to address the frequent challenges he observed in hospitals.
Specifically, families and medical providers often struggle to understand and honor patients’ healthcare wishes due to a lack of clear directives.
In healthcare settings, even well-meaning people can be unsure about who should decide what. Family members may not agree on a plan, or they may believe that love means “do everything,” even when “everything” may be painful, unlikely to help, or contrary to the patient’s values. Clinicians, meanwhile, must balance ethics, legal requirements, and medical realities. When there is no documented guidance, the safest path legally can sometimes be the most aggressive path medically, even if it is not what the patient would choose.
Kottkamp aimed to encourage conversations about advance care planning, making it easier for individuals to communicate their healthcare preferences and for providers to respect those choices.
The initiative began with Virginia Advance Directives Day in 2006, which was highly successful. Building on this success, NHDD was launched nationally in 2008. The day is designed to educate the public and healthcare providers about the importance of advance care planning.
A key piece of the day’s philosophy is that advance directives are not meant to be hidden in a drawer. A document that no one knows exists cannot help when it matters most. NHDD encourages people to complete the paperwork and also to share it with those who will need it: healthcare agents, close family, primary care offices, and anyone else likely to be involved.
NHDD helps people understand the value of documenting their healthcare wishes and appointing a healthcare proxy to make decisions if they are unable to.
Over time, the event has been embraced by a range of community groups and healthcare organizations because it fits a simple, universal need: people want care that respects them. Hospitals, clinics, elder care groups, legal aid organizations, and community educators often use the day as a prompt to distribute forms, host workshops, or normalize conversations that many people avoid until it is too late.
Over the years, NHDD has grown significantly, with numerous community groups and healthcare organizations participating to promote this crucial aspect of patient care.
Host a Family Chat
Grab some snacks, gather everyone, and have a heart-to-heart about healthcare wishes. It’s not just about the serious stuff; add a little humor to lighten the mood. Everyone can share their thoughts on what kind of care they’d prefer, turning a daunting task into a bonding experience. To make the conversation more useful and less overwhelming, it helps to structure it around values rather than medical jargon. Questions that tend to open doors include: What makes a day “a good day” if health is limited?What fears feel bigger than death itself: pain, being dependent, being alone, being confused?If recovery is unlikely, what matters more: more time, more comfort, or more control?Who is the best person to speak on someone’s behalf, and why? It also helps to name practical details. For example, would the person prefer to be cared for at home when possible? Are there cultural or personal preferences around visitors, privacy, or how information is shared? If the family is spread out, who should receive updates first? A gentle ground rule can keep the chat from turning into a debate: the goal is to understand each person’s wishes, not to vote on them. Someone’s plan might look different from what others would choose for themselves, and that is the point. Finally, end the talk with action. Decide who will fill out forms, who will witness or notarize them if needed, and where copies will be stored so they are findable in a real emergency.
Movie Night with a Twist
Why not watch a film that sparks conversations about healthcare decisions? Movies like “The Farewell” or “My Life” can kickstart meaningful discussions. After the film, chat about the themes and how they relate to personal healthcare preferences. It’s entertaining and enlightening. To keep the discussion from drifting into vague “that was sad” territory, choose two or three prompts to talk through: What decisions did the characters make that felt compassionate? Which felt pressured?How did secrecy, family dynamics, or cultural expectations shape the choices?If the main character had completed an advance directive, what might have changed? A movie also provides a safe distance. It is often easier to say, “I didn’t like how the family argued in that scene,” than to jump straight into personal plans. The conversation can then pivot naturally: “If that were us, what would help?” For people who do not enjoy emotional dramas, the “movie night” idea can be swapped for a memoir, podcast episode, or even a well-made documentary. The important part is the shared moment that opens the door.
DIY Advance Directive Workshop
Set up a crafty afternoon where friends and family can create their advance directives. Provide colorful paper, pens, and templates. Everyone can decorate their documents, making the process personal and memorable. Plus, crafting always adds a fun twist! Behind the playful vibe, this is one of the most practical ways to celebrate. An advance directive is only helpful if it is completed correctly. A workshop can include: Printing the appropriate forms for each participant, since requirements can vary by jurisdiction.Setting aside time to read the instructions, especially around signatures and witnesses.Encouraging people to choose a healthcare proxy and list alternate backups in case the first choice cannot be reached.Adding a simple “where to find it” plan: who gets a copy, where the original lives, and how it can be accessed quickly. Decorating the documents is optional, but personalization can increase follow-through. People can add a clear cover sheet with emergency contact info, the name of the healthcare agent, and where other important documents are stored. Some also include a short values statement, a plain-language paragraph about what matters most. That kind of statement can guide decision-making in situations that the form does not specifically address. A workshop is also a good moment to encourage people to talk to their chosen proxy. Naming someone on paper is not enough. The proxy should understand what the person wants and feel comfortable advocating for it, even if other relatives disagree.
Host a Virtual Q&A
Invite a local healthcare professional for a virtual Q&A session. Friends and family can join from anywhere and ask questions about advance care planning. This way, everyone gets reliable information while staying comfy at home, and knowledge sharing becomes a social event. A good Q&A works best with a mix of “big picture” and “nuts and bolts.” Helpful topics might include: What it means to be “unable to make decisions” from a clinical standpoint.How healthcare teams use an advance directive in real situations.Common misconceptions about CPR, ventilators, feeding tubes, and life support.The difference between comfort care, hospice care, and palliative care.How to talk with doctors about goals of care, not just specific treatments. To keep it approachable, participants can submit questions anonymously ahead of time. People often have concerns they are embarrassed to ask out loud, such as whether choosing comfort-focused care means being denied pain treatment (it does not), or whether a proxy can override a written directive (usually not without a strong reason, depending on local rules). It can also be helpful to invite a non-clinical expert, such as a patient advocate, social worker, or attorney familiar with healthcare documents. Clinicians can explain the medical side, while advocates can explain how families can communicate effectively and how paperwork is handled.
Play a “What If” Game
Turn hypothetical scenarios into a fun game. Pose questions like, “What if you couldn’t speak for yourself?” Everyone writes their answers anonymously and then reads them out loud. It’s a playful yet profound way to understand each other’s wishes without pressure. The “What If” game works because it turns a heavy topic into a series of manageable choices. Scenarios can be tailored to the group’s comfort level, ranging from light to serious: What if a person needed help with daily activities long-term?What if treatment could extend life but would mean frequent hospital stays?What if a person could not recognize loved ones anymore?What if a person had a high chance of recovery, but only after weeks of intensive care?What if pain could be controlled, but alertness might be reduced? As answers are shared, patterns often emerge. One person may care most about independence. Another may care about being able to communicate. Another may prioritize staying alive for a milestone, even if the path is difficult. This makes it easier to understand what to write in an advance directive and what to communicate to a proxy. To make the game more actionable, participants can choose one takeaway at the end: a sentence they would want their proxy to remember, one medical intervention they feel strongly about, or one person they trust to make decisions. The game becomes not just thought-provoking, but a step toward real planning. The Evolution and Importance of Advance DirectivesAdvance directives have developed over decades as a way to give individuals a clear voice in their medical care, even when they cannot speak for themselves.From early legal ideas in the 1970s to modern healthcare policies and ongoing gaps in real-world use, these facts highlight how planning ahead has become both a personal responsibility and a critical part of patient-centered care.Advance Directives Grew From a 1970s “Living Will” Movement The modern idea of an advance directive traces back to the late 1960s and early 1970s, when lawyer Luis Kutner proposed the first “living will” as a way for people to record treatment preferences in case they could not speak for themselves. The first living will statute was enacted by California in 1976, and by the early 1990s, most U.S. states had passed laws recognizing some form of living will or durable power of attorney for health care, laying the legal groundwork for today’s advance care planning. U.S. Federal Law Requires Healthcare Facilities to Ask About Advance Directives In the United States, the Patient Self-Determination Act of 1990 requires hospitals, nursing homes, home health agencies, and hospices that participate in Medicare or Medicaid to inform adult patients of their rights to make decisions about medical care and to ask whether they have an advance directive. Facilities must also document the presence or absence of an advance directive in the medical record, which helped normalize conversations about future care in clinical settings. Most Adults Say They Want to Plan, But Far Fewer Have Documents Surveys consistently show a gap between people’s intentions and actions when it comes to advance care planning. A 2017 systematic review of 150 studies found that while many adults say they value documenting their wishes, only about 36.7% of U.S. adults had completed any form of advance directive, and just 29.3% had a living will. Completion rates were somewhat higher among people with chronic illness or those receiving palliative care, but still far from universal. Advance Care Planning Can Align Care With Patients’ Wishes and Ease Family Burden Research has linked advance care planning with better alignment between the care patients receive and the care they say they want, especially near the end of life. A landmark randomized trial in Australia found that older hospital patients who engaged in structured advance care planning were far more likely to have their end-of-life wishes known and respected, and their families reported significantly less stress, anxiety, and depression after the patient’s death compared with usual care. Racial and Ethnic Gaps in Advance Directives Reflect Deeper Mistrust and Access Issues In the United States, non-Hispanic White adults are substantially more likely to have advance directives than Black and Hispanic adults, even after adjusting for income and education. Studies suggest that factors such as historical and ongoing medical mistrust, lower access to consistent primary care, cultural differences in discussing death, and lack of culturally tailored information all contribute to lower completion rates among many minority communities, which can widen disparities in end-of-life care. Different Countries Take Distinct Legal Approaches to Future Healthcare Choices Approaches to advance care planning vary widely across countries. The United Kingdom’s Mental Capacity Act 2005 gives legal force to “advance decisions to refuse treatment” and allows people to appoint a health and welfare attorney. In Canada, provinces such as Ontario recognize “advance care planning” as an ongoing process tied to substitute decision-makers, while Australia’s states and territories each have their own legislation for advance care directives and substitute decision-making, often supported by national frameworks and public guides. Palliative Care and Hospice Programs Rely on Clear Patient Preferences Palliative care and hospice services place a strong emphasis on understanding and honoring what matters most to patients as they approach serious illness or the end of life. Guidelines from organizations such as the World Health Organization and the National Consensus Project in the United States recommend early, structured conversations about goals of care, documentation of preferences in the medical record, and regular review of advance directives so that symptom management, location of care, and life-sustaining treatments can reflect the patient’s values rather than default medical routines. National Healthcare Decisions Day FAQsWhat is the difference between an advance directive, a living will, and a healthcare proxy? An advance directive is a general term for legal documents that state a person’s preferences for future medical care if they become unable to speak for themselves. A living will is one type of advance directive that usually explains which treatments someone would or would not want, such as resuscitation, mechanical ventilation, or tube feeding. A healthcare proxy (also called a durable power of attorney for health care or health care agent) is a person legally appointed to make medical decisions on the patient’s behalf, guided by the patient’s stated values and wishes. [1]Does someone still need an advance directive if they are young and healthy? Health experts recommend that adults of any age consider some form of advance care planning, because serious illness or injury can occur unexpectedly. Even a basic document naming a trusted healthcare proxy can help clinicians and families make decisions that are more closely aligned with the person’s values. These documents can be updated over time as health status, relationships, or personal beliefs change. How often should advance care planning documents be reviewed or updated? Clinicians generally suggest reviewing advance directives whenever there is a major change in health, relationships, or living situation, or at set intervals such as every few years. People are encouraged to revisit their documents after significant life events like a new diagnosis, marriage, divorce, or the death of a loved one, and to revise instructions so they reflect their current goals, beliefs, and understanding of medical options. [1]Are advance directives legally valid in every country and state? Advance care planning is recognized in many countries, but the specific forms, legal requirements, and terms used can vary widely by jurisdiction. In the United States, every state and territory has its own laws governing advance directives, which usually require that forms follow certain wording and be signed and witnessed or notarized. Other countries may emphasize different tools, such as treatment escalation plans or documented conversations, so people are advised to check local regulations and approved forms where they live. [1]Can doctors override a patient’s advance directive? In general, clinicians aim to follow an advance directive as long as it is valid, applicable to the situation, and consistent with current standards of care. However, a doctor may not follow a directive if it conflicts with emergency treatment laws, hospital policy, or professional ethics, or if the document is unclear or does not address the specific medical circumstance. In such cases, the healthcare team will usually consult the patient’s healthcare proxy and, if needed, an ethics committee to interpret the patient’s likely wishes. How should families start a conversation about future medical care without causing alarm? Experts recommend beginning with everyday language about values and quality of life rather than specific medical procedures. People can ask open questions, such as what matters most if they become seriously ill, where they would prefer to receive care, or how they feel about intensive treatments that might extend life but limit independence. Using conversation guides, question lists, or examples from news stories or films can make the discussion feel more natural and less threatening, and returning to the topic over time helps normalize it. [1] What are some common misconceptions about advance care planning? Common misunderstandings include the belief that advance directives are only for people who are very old or already dying, or that completing one means medical teams will withhold all treatment. In reality, advance care planning can specify a wide range of preferences, from full life-prolonging care to comfort-focused approaches, and it can be revised at any time. Another misconception is that a single form is enough, when in fact effective planning often involves both written documents and clear conversations with loved ones and clinicians.