Advanced Care Planning is the process in which patients and their clinicians engage in evolving discussions about goals of care, including what matters most to the patient, care preferences at the end of life or in the case of a medical emergency. It includes understanding a patient’s health status and care options in the context of their values and goals, forming and documenting a plan, communicating the plan to loved ones and the medical team in case they cannot do so in the future, reviewing the plan periodically to ensure that it reflects their current care preferences, especially with changes in health and enacting the plan under appropriate circumstances.

The one question I ask my patients to answer truthfully is “What matters most to you at this time?” It is often difficult to answer the question right away. But the idea of this exercise is not to put them on the spot but to direct them in the appropriate way to think so they can have a meaningful life.

Advanced directives, also called advance care directives, document a patient’s future healthcare preferences. They include living will, surrogate designating documents which designates someone to be the legal power of attorney for the patient. Patients who lack decision making capacity need others to make medical decisions on their behalf. Surrogates are expected to make decisions they believe the patient would have made through applying the substituted judgment standard.

Anyone who would like to ask me a medical question relating to the health of older adults can email me at I hope to provide a helpful answer in a future issue of this newspaper.

Disclaimer: The information shared in this column is based on current practice guidelines but is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your healthcare provider with any questions regarding a medical condition.

Dr. Arvindselvan Mohanaselvan, M.D.,is a physician board certified in internal medicine, with a subspecialty in geriatrics. He currently works at Apex Medical Group as a primary care and geriatric medicine provider. Email questions for Paging the Doctor on Call to

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