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Download and print your Starter Kit PDF

Translations in French, Hebrew, Korean, Mandarin, Russian, Spanish and Vietnamese are available here.

NEW - Download and print the Alzheimer's Disease and Other Forms of Dementia Starter Kit PDF 


Download and print the How To Talk To Your Doctor Guide PDF 


Translations in French, Korean, Mandarin and Spanish are available here.


Download and print the Pediatric Starter Kit PDF 


Translations in Spanish and Mandarin are available here. 


NOTE: If you are using a Google Chrome browser, you must save the PDF to your desktop and reopen it before entering your answers.
How to use the Starter Kit
  • Move straight through by clicking the arrows at the bottom of the page, or navigate to the section you’d like to explore by clicking on the progress bar at the top of the page.
  • Get extra help through every step by downloading and printing out the Starter Kit PDF from the top of the page. You can now type your answers directly into the Starter Kit, save your personalized version, finish or change it later, and email it to family and friends.
Remember:
  • This can be the first of many conversations, so you don’t have to cover everyone or everything right now.

Step 2: Get Set

What’s most important to you as you think about how you want to live at the end of your life? What do you value most? Thinking about this will help you get ready to have the conversation.

Now finish this sentence:

“What matters to me at the end of life is….”

(For example, being able to recognize my children; being in the hospital with excellent nursing care; being able to say goodbye to the ones I love.)

Sharing your “what matters to me” statement with your loved ones could be a big help down the road. It could help them communicate to your doctor what abilities are most important to you—what’s worth pursuing treatment for, and what isn’t.

Here are a few statements to get you thinking:

Mom with kids“What matters to me is being able to recognize my kids.”
Older gentleman“What matters to me is being able to eat chocolate ice cream and watch football on TV.”

Where I Stand Scales

Ready to dig deeper? Use the scales below to figure out how you want your end-of-life care to be.

Select the number that best represents your feelings on the given scenario.

As a patient, I’d like to know…

1 2 3 4 5
Only the basics about my condition and my treatment All the details about my condition and my treatment

As doctors treat me, I would like…

1 2 3 4 5
My doctors to do what they think is best To have a say in every decision

If I had a terminal illness, I would prefer to…

1 2 3 4 5
Not know how quickly it is progressing Know my doctor’s best estimation for how long I have to live

Look at your answers. What kind of role do you want to have in the decision-making process?

How long do you want to receive medical care?

1 2 3 4 5
Indefinitely, no matter how uncomfortable treatments are Quality of life is more important to me than quantity

What are your concerns about treatment?

1 2 3 4 5
I’m worried that I won’t get enough care I’m worried that I’ll get overly aggressive care

What are your preferences about where you want to be?

1 2 3 4 5
I wouldn’t mind spending my last days in a health care facility I want to spend my last days at home

Look at your answers. What do you notice about the kind of care you want to receive?

How involved do you want your loved ones to be?

1 2 3 4 5
I want my loved ones to do exactly what I’ve said, even if it makes them a little uncomfortable I want my loved ones to do what brings them peace, even if it goes against what I’ve said

When it comes to your privacy…

1 2 3 4 5
When the time comes, I want to be alone I want to be surrounded by my loved ones

When it comes to sharing information…

1 2 3 4 5
I don’t want my loved ones to know everything about my health I am comfortable with those close to me knowing everything about my health

Look at your answers. What role do you want your loved ones to play? Do you think that your loved ones know what you want, or do you think they have no idea?

PLEASE NOTE: This document does not seek to provide legal advice.

Download and print your Starter Kit PDF

Translations in French, Hebrew, Korean, Mandarin, Russian, Spanish and Vietnamese are available here.

NEW - Download and print the Alzheimer's Disease and Other Forms of Dementia Starter Kit PDF 


Download and print the How To Talk To Your Doctor Guide PDF 


Translations in French, Korean, Mandarin and Spanish are available here.


Download and print the Pediatric Starter Kit PDF 


Translations in Spanish and Mandarin are available here. 


NOTE: If you are using a Google Chrome browser, you must save the PDF to your desktop and reopen it before entering your answers.
How to use the Starter Kit
  • Move straight through by clicking the arrows at the bottom of the page, or navigate to the section you’d like to explore by clicking on the progress bar at the top of the page.
  • Get extra help through every step by downloading and printing out the Starter Kit PDF from the top of the page. You can now type your answers directly into the Starter Kit, save your personalized version, finish or change it later, and email it to family and friends.
Remember:
  • This can be the first of many conversations, so you don’t have to cover everyone or everything right now.

Do you have a good idea about what your wishes are? It’s time to plan for and have the conversation.

Help us make this kit better.

Tell us what you think works, what doesn't work, and what else you need.