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. Medical emergencies can arrive with zero warning, and serious illness can make it hard to speak up in the moment. National Healthcare Decisions Day invites individuals to put their preferences into words, choose someone they trust to speak on their behalf if needed, and share those choices so loved ones and clinicians are not left guessing.
This day highlights the need for advance care planning, ensuring that individuals’ preferences for medical treatment are familiar to everyone involved. This practice often reduces the stress and uncertainty that often accompany serious illness or end-of-life decisions.
Advance care planning is not only for older adults, people with chronic conditions, or those facing surgery. It is for anyone who wants their voice to be heard, even if they cannot communicate. It also tends to be kinder to families. When wishes are clearly documented and discussed, relatives and caregivers can focus on support and presence instead of debating what someone “would have wanted.”
Reasons for Celebrating National Healthcare Decisions Day
Celebrating National Healthcare Decisions Day promotes awareness about the significance of planning for future healthcare needs.
It helps individuals understand the importance of having advance directives, such as living wills and healthcare proxies, in place.
These documents ensure that one’s healthcare preferences are honored, even when they are unable to communicate. By encouraging conversations about healthcare wishes, this day aims to demystify advanced care planning and make it a routine part of life.
One of the biggest reasons this day matters is that healthcare decisions often come bundled with emotions, time pressure, and complicated information. In a crisis, a clinician may need quick answers to questions like:
- Would the person want cardiopulmonary resuscitation if their heart stops?
- Would they want to be on a breathing machine, and if so, for how long?
- If a medical condition is not reversible, would comfort-focused care be preferred over aggressive treatments?
- Who should be contacted for decisions when the patient cannot participate?
Without guidance, loved ones may disagree, or they may agree but remain haunted by doubt afterward. An advance directive helps turn guesswork into a plan.
National Healthcare Decisions Day also supports better communication with healthcare professionals. Many people assume doctors can simply read their minds or “do what’s best,” but “best” can mean very different things depending on personal values.
Some people prioritize living as long as possible, even with intensive interventions. Others prioritize comfort, being at home, or avoiding burdensome procedures. A well-considered plan gives medical teams something they can ethically and practically follow.
Another reason to celebrate the day is that it reframes advance care planning as an act of care, not an act of pessimism. Writing down preferences is not “giving up.” It is setting boundaries, expressing hopes, and naming what matters most.
For example, a person might value being able to recognize family, maintain independence, or avoid prolonged hospitalization. Those values can guide decisions beyond a simple checklist of procedures.
It is also a chance to clear up common misunderstandings:
- A living will typically describes the types of care someone would or would not want under certain medical circumstances, especially if they cannot speak for themselves.
- A healthcare proxy (also called a healthcare agent or medical power of attorney in some places) is a person chosen to make healthcare decisions when the patient cannot.
- A do-not-resuscitate order (DNR) is a medical order, created in conversation with a clinician, that addresses whether CPR should be attempted if breathing or heartbeat stops. It is not the same as a living will.
- POLST/MOLST forms (names vary) are medical orders intended for people with serious illness or frailty and are designed to travel with the patient across care settings. They generally do not replace an advance directive but can complement it.
By bringing these distinctions into everyday conversation, National Healthcare Decisions Day helps people choose the right tools for their situation.
The ultimate goal is to enhance the quality of care and ease the emotional burden on families and caregivers. When preferences are documented and shared, families often feel more confident, clinicians can align treatment with stated goals, and patients are more likely to receive the kind of care they actually want.
National Healthcare Decisions Day Timeline
First U.S. Living Will Proposal
Attorney Luis Kutner publishes a law review article proposing the “living will,” a document for people to state wishes about life-sustaining treatment if they cannot speak for themselves.
New Jersey’s Quinlan Decision
In re Quinlan, involving Karen Ann Quinlan, became the first major U.S. court case to recognize a patient’s right, through family, to refuse life-sustaining treatment such as a ventilator.
Patient Self-Determination Act
The U.S. Congress passed the Patient Self-Determination Act, requiring many healthcare facilities to inform adults of their rights to make advance directives and refuse medical treatment.
Supreme Court’s Cruzan Ruling
In Cruzan v. Director, Missouri Department of Health, the U.S. Supreme Court affirms that competent adults have a constitutional right to refuse medical treatment and highlights the value of clear advance directives.
Washington v. Glucksberg and Vacco v. Quill
The U.S. Supreme Court rules that there is no constitutional right to physician-assisted suicide while reaffirming the distinction between refusing treatment and assisted dying.
The Terri Schiavo Case
A prolonged legal battle over the removal of a feeding tube from Terri Schiavo in Florida drew national attention to end-of-life choices and the importance of written healthcare directives.
Growth of POLST and Serious Illness Planning
Physician Orders for Life-Sustaining Treatment (POLST) programs spread across many U.S. states, translating patients’ end-of-life preferences into actionable medical orders for serious illness.
History of National Healthcare Decisions Day
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.
How to Celebrate National Healthcare Decisions Day
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 Directives
Advance 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.
